Healthcare Provider Details

I. General information

NPI: 1215913371
Provider Name (Legal Business Name): MICHAEL JOSEPH ATTILIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7980 STATE ROUTE 12
BARNEVELD NY
13304-2536
US

IV. Provider business mailing address

2209 GENESEE STREET BUSINESS OFFICE ROOM 315
UTICA NY
13501-5930
US

V. Phone/Fax

Practice location:
  • Phone: 315-624-8440
  • Fax:
Mailing address:
  • Phone: 315-801-3282
  • Fax: 315-801-8391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number260932
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: