Healthcare Provider Details

I. General information

NPI: 1285035006
Provider Name (Legal Business Name): MR. MICHAEL DENICOLA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2014
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 HYLAN BLVD
STATEN ISLAND NY
10306-3611
US

IV. Provider business mailing address

36 ASHWOOD CT
STATEN ISLAND NY
10308-1881
US

V. Phone/Fax

Practice location:
  • Phone: 917-696-1573
  • Fax: 888-283-3353
Mailing address:
  • Phone: 917-696-1573
  • Fax: 888-283-3353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: