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General NPI Number Information
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NPI Number | 1235101932
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Entity Type | Organization
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Legal Business Name | MICHAEL PICCARELLI DPM
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Dates
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Enumeration Date | 02/06/2006
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Last Update Date | 01/24/2012
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Provider Practice Location Address
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Address Line | 1478 VICTORY BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10301-3915
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Country | US
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Telephone | 718-273-0123
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Fax |
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Provider Business Mailing Address
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Address Line | 1478 VICTORY BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10301-3915
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SELF PROPRIETER
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Name | MICHAEL PICCARELLI
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Credential |
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Telephone | 718-273-0123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | N006042
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License Number State | NY
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