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General NPI Number Information
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NPI Number | 1285035006
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Entity Type | Individual
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Provider Name | MR. MICHAEL DENICOLA
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Gender | Male
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Dates
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Enumeration Date | 09/11/2014
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Last Update Date | 09/11/2014
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Provider Practice Location Address
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Address Line | 3311 HYLAN BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10306-3611
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Country | US
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Telephone | 917-696-1573
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Fax | 888-283-3353
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Provider Business Mailing Address
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Address Line | 36 ASHWOOD CT
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City | STATEN ISLAND
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State | NY
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Zip | 10308-1881
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Country | US
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Telephone | 917-696-1573
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Fax | 888-283-3353
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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 | 225000000X
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Taxonomy Name | Orthotic Fitter
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License Number |
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License Number State |
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