Provider Demographics
NPI:1154309441
Name:MARCHISELLI, MICHAEL P (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:P
Last Name:MARCHISELLI
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 FOREST AVE
Mailing Address - Street 2:SUITE #2A
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542
Mailing Address - Country:US
Mailing Address - Phone:516-676-2327
Mailing Address - Fax:516-676-4960
Practice Address - Street 1:70 FOREST AVE
Practice Address - Street 2:SUITE #2A
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542
Practice Address - Country:US
Practice Address - Phone:516-676-2327
Practice Address - Fax:516-676-4960
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015888225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ19P5QI681Medicare PIN