Provider Demographics
NPI:1114161296
Name:NIESI, MICHAEL JOHN (MA,CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOHN
Last Name:NIESI
Suffix:
Gender:M
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 WAIMER PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-4133
Mailing Address - Country:US
Mailing Address - Phone:347-838-6849
Mailing Address - Fax:347-838-6849
Practice Address - Street 1:49 WAIMER PL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-4133
Practice Address - Country:US
Practice Address - Phone:347-838-6849
Practice Address - Fax:347-838-6849
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012117235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist