Provider Demographics
NPI:1326586934
Name:CHESHIRE, MICHAEL JAY JR (ATC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JAY
Last Name:CHESHIRE
Suffix:JR
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 N JERUSALEM RD
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-1128
Mailing Address - Country:US
Mailing Address - Phone:516-242-3365
Mailing Address - Fax:
Practice Address - Street 1:3110 N JERUSALEM RD
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-1128
Practice Address - Country:US
Practice Address - Phone:516-242-3365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003008-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer