Robert Charles Mickatavage, MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

092072 Issued in NY

Practice address

3020 Westchester Ave
Ste 101
Purchase, NY 10577

Phone

(914) 967-4400

Fax

(914) 967-6416

NPI assigned

Jul 28, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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

• Robert C Mickatavage MD PC

  • Ophthalmology Physician
  • Purchase, NY
  • NPI 1720093453
  NPD (past)
• Robert Latkany MD PC

  • Ophthalmology Physician
  • Rye, NY
  • NPI 1780856690
  NPD (past)

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285718400000",
    "number": "1578577375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3020 WESTCHESTER AVE",
            "address_2": "STE 101",
            "city": "PURCHASE",
            "state": "NY",
            "postal_code": "10577",
            "telephone_number": "914-967-4400",
            "fax_number": "914-967-6416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3020 WESTCHESTER AVE",
            "address_2": "STE 101",
            "city": "PURCHASE",
            "state": "NY",
            "postal_code": "10577",
            "telephone_number": "914-967-4400",
            "fax_number": "914-967-6416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICKATAVAGE",
        "first_name": "ROBERT",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2010-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NY",
            "license": "092072",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "WS1186",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MC",
            "identifier": "180037724",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00565513",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexis K Masbou, MD
• Hillary Jade Mazzella-Morales
• Tyler Matthew McBeth, DNP, FNP
• Caitlin McNally, LCSW
• Rachel Meadows
• Michael R Miler, MD
• Shaghayegh Mirshahi, M.D.
• Abraham Mittelman, MD
• Edward Monk, MD
• Montefiore Medical Center

• Ophthalmology Physician in Purchase, NY
• Providers in Purchase, NY by specialty
• Ophthalmology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.