Healthcare Provider Details

I. General information

NPI: 1265517221
Provider Name (Legal Business Name): MICHELLE RENEE MICHITSCH CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 06/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 FULTON AVE SUITE 100
HEMPSTEAD NY
11550-3718
US

IV. Provider business mailing address

38 REDWING LN
LEVITTOWN NY
11756-2132
US

V. Phone/Fax

Practice location:
  • Phone: 516-292-1034
  • Fax: 516-292-0565
Mailing address:
  • Phone: 516-520-1947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF381247
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: