Provider Demographics
NPI:1528878774
Name:DAVIS, MICHAEL JR (RN)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:DAVIS
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 AVE AT PORT IMPERIAL APT 140
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-8404
Mailing Address - Country:US
Mailing Address - Phone:917-539-3273
Mailing Address - Fax:
Practice Address - Street 1:70 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5501
Practice Address - Country:US
Practice Address - Phone:917-539-3273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY749959163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency