Provider Demographics
NPI:1043579691
Name:FORTE, MICHELE YEXENIA
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:YEXENIA
Last Name:FORTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 W 155TH ST
Mailing Address - Street 2:SUITE145
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-6304
Mailing Address - Country:US
Mailing Address - Phone:212-690-3014
Mailing Address - Fax:212-368-5978
Practice Address - Street 1:475 W 155TH ST
Practice Address - Street 2:SUITE145
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-6304
Practice Address - Country:US
Practice Address - Phone:212-690-3014
Practice Address - Fax:212-368-5978
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005125225X00000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist