Individual provider Active NPI

Brian John Davitt

  • Pediatric Emergency Medicine (Emergency Medicine) Physician
  • Brooklyn, NY
National Provider Identifier
1417584392
Registry record updated Dec 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Emergency Medicine (Emergency Medicine) PhysicianTaxonomy code 207PP0204X
License
322434 Issued in NY
Practice address
4802 10TH Ave
Brooklyn, NY 11219-2916
Phone
(718) 283-6000
NPI assigned
Mar 23, 2020
Last updated
Dec 30, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Pediatric Emergency Medicine (Emergency Medicine) Physician 207PP0204X 322434 NY Primary

Addresses

Primary practice location

4802 10TH Ave
Brooklyn, NY 11219-2916

Mailing address

4802 10TH Ave
Brooklyn, NY 11219-2916
Phone (718) 283-6326

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241021001330 NY Practitioner - Pediatric MedicinePractitioner - Emergency Medicine 7012449655 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
322434NYMDPediatric Emergency Medicine (Emergency Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Interfaith Emergency Medicine, P.C. CurrentSince Sep 1, 2024 Accepting new patients
The Brookdale Hospital Medical Center CurrentSince Dec 5, 2024 Accepting new patients
Brookdale Hospital Medical Center CurrentSince Dec 5, 2024 Accepting new patients

Locations

1235 Linden Blvd
Fl 2
Brooklyn, NY 11212
Phone (718) 240-7143

1545 Atlantic Ave
Brooklyn, NY 11213
Phone (718) 613-4175

1545 Atlantic Ave
Fl 3
Brooklyn, NY 11213
Phone (617) 216-0149

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1584921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735516800000",
    "number": "1417584392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4802 10TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112192916",
            "telephone_number": "718-283-6326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4802 10TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112192916",
            "telephone_number": "718-283-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVITT",
        "first_name": "BRIAN",
        "middle_name": "JOHN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-23",
        "last_updated": "2024-12-30",
        "certification_date": "2024-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207PP0204X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Pediatric Emergency Medicine",
            "state": "NY",
            "license": "322434",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.