Provider Demographics
NPI:1407220106
Name:MICHAEL J ERRICO, MD PC
Entity Type:Organization
Organization Name:MICHAEL J ERRICO, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ERRICO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-627-4242
Mailing Address - Street 1:585 PLANDOME RD
Mailing Address - Street 2:SUITE 104C
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-1971
Mailing Address - Country:US
Mailing Address - Phone:516-627-4242
Mailing Address - Fax:516-627-5460
Practice Address - Street 1:585 PLANDOME RD
Practice Address - Street 2:SUITE 104C
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-1971
Practice Address - Country:US
Practice Address - Phone:516-627-4242
Practice Address - Fax:516-627-5460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-18
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7511750001Medicare NSC
NYA100136573Medicare PIN