MEDICARE: MR. MICHAEL CORMICAN PT

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	225100000X	Physical Therapist	012035	NY

General Provider Information

NPI Number	:	1912064452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL CORMICAN PT

Provider Business Mailing Address
First Line	:	14 HEWITT RD
Second Line	:
City	:	ROCKVILLE CENTRE
State	:	NY
Zip	:	11570-1630
Country	:	US
Telephone Number	:	516-678-1811
Fax Number	:	516-678-2442

Provider Business Practice Location Address
First Line	:	303 PARK AVE S
Second Line	:	#1243
City	:	NEW YORK
State	:	NY
Zip	:	10010-3601
Country	:	US
Telephone Number	:	646-742-0165
Fax Number	:	646-742-0462

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

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	01/07/2011

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Directions to “ MR. MICHAEL CORMICAN PT” Practice Location

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