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NPI Code Detail

MEDICARE: MR. MICHAEL DENICOLA

MEDICARE: MR. MICHAEL DENICOLA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225000000XOrthotic Fitter

General Provider Information

NPI Number : 1285035006
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL DENICOLA
Provider Business Mailing Address
First Line : 36 ASHWOOD CT
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10308-1881
Country : US
Telephone Number : 917-696-1573
Fax Number : 888-283-3353
Provider Business Practice Location Address
First Line : 3311 HYLAN BLVD
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10306-3611
Country : US
Telephone Number : 917-696-1573
Fax Number : 888-283-3353
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2014
Last Update Date : 09/11/2014

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