MEDICARE: MICHELLE ANNE CANERO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	053527	NY
2	225100000X	Physical Therapist	050355-1	NY

General Provider Information

NPI Number	:	1104625086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE ANNE CANERO

Provider Business Mailing Address
First Line	:	279 CLARK ST. A16
Second Line	:
City	:	HACKENSACK
State	:	NJ
Zip	:	07601
Country	:	US
Telephone Number	:	352-316-0800
Fax Number	:

Provider Business Practice Location Address
First Line	:	25-21 49TH STREET
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11103
Country	:	US
Telephone Number	:	347-829-3890
Fax Number	:	347-829-3888

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2025
Last Update Date	:	02/12/2026

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Directions to “ MICHELLE ANNE CANERO ” Practice Location

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