Healthcare Provider Details

I. General information

NPI: 1952316499
Provider Name (Legal Business Name): FABRIZIO MICHELASSI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 YORK AVE 2ND FLOOR
NEW YORK NY
10021-5304
US

IV. Provider business mailing address

525 E 68TH ST SUITE F-739, MAILBOX 129
NEW YORK NY
10021-4870
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-6006
  • Fax:
Mailing address:
  • Phone: 212-746-5144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number140048
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number140048
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: