MEDICARE: FABRIZIO MICHELASSI M.D.

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	208600000X	Surgery Physician	140048	NY
2	208C00000X	Colon & Rectal Surgery Physician	140048	NY

General Provider Information

NPI Number	:	1952316499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FABRIZIO MICHELASSI M.D.

Provider Business Mailing Address
First Line	:	525 E 68TH ST
Second Line	:	SUITE F-739, MAILBOX 129
City	:	NEW YORK
State	:	NY
Zip	:	10021-4870
Country	:	US
Telephone Number	:	212-746-5144
Fax Number	:

Provider Business Practice Location Address
First Line	:	1315 YORK AVE
Second Line	:	2ND FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10021-5304
Country	:	US
Telephone Number	:	212-746-6006
Fax Number	:

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	12/20/2011

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