Healthcare Provider Details

I. General information

NPI: 1639280670
Provider Name (Legal Business Name): MICHAEL F CARDO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 12/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6070 WOODHAVEN BLVD
ELMHURST NY
11373-5554
US

IV. Provider business mailing address

112 VAN GUILDER AVE
NEW ROCHELLE NY
10801-5406
US

V. Phone/Fax

Practice location:
  • Phone: 718-897-6400
  • Fax:
Mailing address:
  • Phone: 914-960-5421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number049309
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: