Healthcare Provider Details

I. General information

NPI: 1316039464
Provider Name (Legal Business Name): MICHAEL DAVID NADATA C.P.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 03/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 E SUNRISE HWY
VALLEY STREAM NY
11581-1315
US

IV. Provider business mailing address

214 E SUNRISE HWY
VALLEY STREAM NY
11581-1315
US

V. Phone/Fax

Practice location:
  • Phone: 516-239-0990
  • Fax: 516-239-6555
Mailing address:
  • Phone: 516-239-0990
  • Fax: 516-239-6555

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: