MEDICARE: MICHAEL PITTELLI OD

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	152W00000X	Optometrist	6251	NY
2	152W00000X	Optometrist	1337	AZ

General Provider Information

NPI Number	:	1225192719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL PITTELLI OD

Provider Business Mailing Address
First Line	:	532 BROADWAY
Second Line	:
City	:	MASSAPEQUA
State	:	NY
Zip	:	11758-5004
Country	:	US
Telephone Number	:	516-798-2635
Fax Number	:	631-598-4496

Provider Business Practice Location Address
First Line	:	532 BROADWAY
Second Line	:
City	:	MASSAPEQUA
State	:	NY
Zip	:	11758-5004
Country	:	US
Telephone Number	:	516-798-2635
Fax Number	:

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

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	06/02/2026

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