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NPI Code Detail

MEDICARE: DR. PETER JOSEPH MICELI M.D.

MEDICARE: DR. PETER JOSEPH MICELI M.D.
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
1207Y00000XOtolaryngology Physician177014NY

General Provider Information

NPI Number : 1487701777
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PETER JOSEPH MICELI M.D.
Provider Business Mailing Address
First Line : 660 WHITE PLAINS RD FL 4
Second Line :
City : TARRYTOWN
State : NY
Zip : 10591-5139
Country : US
Telephone Number : 914-984-2546
Fax Number :
Provider Business Practice Location Address
First Line : 1 TELEPORT DR STE 200
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10311-1000
Country : US
Telephone Number : 917-830-0941
Fax Number : 718-370-6733
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2007
Last Update Date : 04/03/2019

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Directions to “ DR. PETER JOSEPH MICELI M.D.” Practice Location

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