Healthcare Provider Details

I. General information

NPI: 1083549877
Provider Name (Legal Business Name): MICHAEL PALAZZO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 INDIAN HEAD RD STE 101
KINGS PARK NY
11754-4803
US

IV. Provider business mailing address

576 BROADHOLLOW RD
MELVILLE NY
11747-5012
US

V. Phone/Fax

Practice location:
  • Phone: 631-359-5859
  • Fax:
Mailing address:
  • Phone: 631-359-5859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: