Provider Demographics
NPI:1356476451
Name:MORGAN, MICHAEL MARCOS (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:MARCOS
Last Name:MORGAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:469 7 TH AVENUE
Mailing Address - Street 2:SUITE 327-328 3RD FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:11422-1329
Mailing Address - Country:US
Mailing Address - Phone:212-359-9516
Mailing Address - Fax:718-775-3419
Practice Address - Street 1:235-20 147TH STREET
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422
Practice Address - Country:US
Practice Address - Phone:347-894-9860
Practice Address - Fax:347-894-9878
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22691225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY246075Medicaid
NY0033T231Medicare ID - Type Unspecified