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General NPI Number Information
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NPI Number | 1124241260
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Entity Type | Individual
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Provider Name | MICHAEL RICHARD MIRABELLA MS, ATC, CSCS
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Gender | Male
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 550 NORTH ST DEPARTMENT OF ATHLETICS
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City | WHITE PLAINS
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State | NY
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Zip | 10605-3004
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Country | US
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Telephone | 914-422-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 88 TODD HILL RD
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City | POUGHKEEPSIE
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State | NY
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Zip | 12603-3923
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Country | US
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Telephone | 845-473-4169
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 000860
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License Number State | NY
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