Healthcare Provider Details

I. General information

NPI: 1801180039
Provider Name (Legal Business Name): MSK MEDICAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 06/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HICKSVILLE RD
MASSAPEQUA NY
11758-5823
US

IV. Provider business mailing address

100 HICKSVILLE RD
MASSAPEQUA NY
11758-5823
US

V. Phone/Fax

Practice location:
  • Phone: 516-799-5407
  • Fax: 516-799-5452
Mailing address:
  • Phone: 516-799-5407
  • Fax: 516-799-5452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ENRICO PALAZZO
Title or Position: MANAGER
Credential:
Phone: 516-799-5407