MEDICARE: DR. MICHAEL POLITI D.O

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	207W00000X	Ophthalmology Physician	280492	NY
2	207WX0107X	Retina Specialist (Ophthalmology) Physician	280492	NY

General Provider Information

NPI Number	:	1669886636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL POLITI D.O

Provider Business Mailing Address
First Line	:	14 GLEN COVE RD STE 3
Second Line	:
City	:	ROSLYN HEIGHTS
State	:	NY
Zip	:	11577-1732
Country	:	US
Telephone Number	:	516-403-2565
Fax Number	:	936-209-5957

Provider Business Practice Location Address
First Line	:	14 GLEN COVE RD STE 3
Second Line	:
City	:	ROSLYN HEIGHTS
State	:	NY
Zip	:	11577-1732
Country	:	US
Telephone Number	:	516-500-3909
Fax Number	:	936-209-5957

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2014
Last Update Date	:	10/04/2024

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