MEDICARE: DR. MICHELLE CREMONINI OD

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	152W00000X	Optometrist	009926	NY

General Provider Information

NPI Number	:	1881460640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE CREMONINI OD

Provider Business Mailing Address
First Line	:	1 SUNNYSIDE LN
Second Line	:
City	:	NEW FAIRFIELD
State	:	CT
Zip	:	06812-3121
Country	:	US
Telephone Number	:	203-300-4491
Fax Number	:

Provider Business Practice Location Address
First Line	:	20B N SALEM RD
Second Line	:
City	:	CROSS RIVER
State	:	NY
Zip	:	10518-1104
Country	:	US
Telephone Number	:	914-763-0560
Fax Number	:

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

Provider Enumeration Date	:	12/01/2023
Last Update Date	:	12/01/2023

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