Provider Demographics
NPI:1225452204
Name:STORZ, MICHELLE (MS ED)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:STORZ
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 BEDELL PL
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-3302
Mailing Address - Country:US
Mailing Address - Phone:631-983-8563
Mailing Address - Fax:
Practice Address - Street 1:26 BEDELL PL
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-3302
Practice Address - Country:US
Practice Address - Phone:631-983-8563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY454598101174400000X
NY430878101174400000X
NY822475141174400000X
NY822317141174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist