Provider Demographics
NPI:1275520991
Name:FIORILLO, MICHAEL A (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:FIORILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 S PEARL ST
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-2253
Mailing Address - Country:US
Mailing Address - Phone:845-623-6141
Mailing Address - Fax:845-623-1998
Practice Address - Street 1:150 S PEARL ST
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965-2253
Practice Address - Country:US
Practice Address - Phone:845-623-6141
Practice Address - Fax:845-623-1998
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06367300208200000X, 2082S0105X
NY1967152082S0105X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ958394Medicare ID - Type Unspecified
NY5T948XRRZ1Medicare PIN
NYG54905Medicare UPIN