Individual provider Active NPI

Marvin Witt III, MD

  • Internal Medicine Physician
  • New York, NY
National Provider Identifier
1891892915
Registry record updated Oct 1, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
1734951 Issued in NY
Practice address
590 Fifth Avenue
New York, NY 10036-4702
Phone
(212) 582-7117
Fax
(212) 484-3531
NPI assigned
Sep 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 1734951 NY Primary

Addresses

Primary practice location

590 Fifth Avenue
New York, NY 10036-4702

Mailing address

55 Water St
2ND Floor Cred Dept
New York, NY 10041-0004
Phone (646) 680-2888

Other identifiers 1

IdentifierTypeStateIssuer
01723317MedicaidNY

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
I20111003000232 NY Practitioner - Internal Medicine 7618928086 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
1734951NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advantagecare Physicians PC CurrentSince Jan 1, 2017 Accepting new patients
Advantagecare Physicians PC Internal Medicine CurrentSince Jan 1, 2017 Accepting new patients

Locations

233 Nostrand Ave
Brooklyn, NY 11205
Phone (646) 680-1595

3175 23rd St
Long Island City, NY 11106
Phone (718) 956-2200

55 Water St
Fl 2
New York, NY 10041

215 E 95th St
New York, NY 10128
Phone (212) 423-3111

590 5th Ave
New York, NY 10036
Phone (212) 582-7117

Interoperability endpoints

  • FHIR API: https://epwebapps.acpny.com/FHIRproxy/ACPNY/api/FHIR/R4

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569888000000",
    "number": "1891892915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 WATER ST",
            "address_2": "2ND FLOOR CRED DEPT",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100410004",
            "telephone_number": "646-680-2888",
            "fax_number": "516-542-5556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "590 FIFTH AVENUE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100364702",
            "telephone_number": "212-582-7117",
            "fax_number": "212-484-3531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WITT",
        "first_name": "MARVIN",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2019-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "1734951",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01723317",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.