Healthcare Provider Details

I. General information

NPI: 1740488451
Provider Name (Legal Business Name): MICHAEL A PISACANO MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2590 FRISBY AVE
BRONX NY
10461-3240
US

IV. Provider business mailing address

2590 FRISBY AVE
BRONX NY
10461-3240
US

V. Phone/Fax

Practice location:
  • Phone: 718-409-9400
  • Fax: 718-409-9440
Mailing address:
  • Phone: 718-409-9400
  • Fax: 718-409-9440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number230158
License Number StateNY

VIII. Authorized Official

Name: MICHAEL ANTHONY PISACANO
Title or Position: PRESIDENT
Credential:
Phone: 718-409-9400