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NPI Code Detail

MEDICARE: MR. MICHAEL GIGNOUX UPSTON I LCSW

MEDICARE: MR. MICHAEL GIGNOUX UPSTON I LCSW
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
11041C0700XClinical Social WorkerR062739-1NY

General Provider Information

NPI Number : 1306921465
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL GIGNOUX UPSTON I LCSW
Provider Business Mailing Address
First Line : 5424 ARLINGTON AVE APT H61
Second Line :
City : BRONX
State : NY
Zip : 10471-1273
Country : US
Telephone Number : 718-432-0099
Fax Number :
Provider Business Practice Location Address
First Line : 750 ASTOR AVE
Second Line :
City : BRONX
State : NY
Zip : 10467-9304
Country : US
Telephone Number : 718-882-5000
Fax Number : 718-798-7633
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2006
Last Update Date : 07/08/2007

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