MEDICARE: MICHELLE CARISSIMI LLC

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
1	174400000X	Specialist	1637607	NY

General Provider Information

NPI Number	:	1487078051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHELLE CARISSIMI LLC

Provider Business Mailing Address
First Line	:	1464 76TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-2408
Country	:	US
Telephone Number	:	347-782-3257
Fax Number	:

Provider Business Practice Location Address
First Line	:	1464 76TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-2408
Country	:	US
Telephone Number	:	347-782-3257
Fax Number	:

Authorized Official
Title or Position	:	SPECIAL EDUCATION TEACHER
Name	:	MICHELLE JANINE CARISSIMI
Credential	:	MSED
Telephone Number	:	347-782-3257

Provider Enumeration Date	:	02/18/2014
Last Update Date	:	02/18/2014

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Directions to “MICHELLE CARISSIMI LLC ” Practice Location

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