Healthcare Provider Details

I. General information

NPI: 1487171427
Provider Name (Legal Business Name): MICHAEL MACCHIARULO DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2017
Last Update Date: 07/31/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1188 WILLIS AVE # 326
ALBERTSON NY
11507-1229
US

IV. Provider business mailing address

1188 WILLIS AVE
ALBERTSON NY
11507-1229
US

V. Phone/Fax

Practice location:
  • Phone: 347-236-9971
  • Fax:
Mailing address:
  • Phone: 347-236-9971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number041846
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier041846
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerLICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: