Provider Demographics
NPI:1407488505
Name:DECASPERIS, MICHAEL (ATS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:DECASPERIS
Suffix:
Gender:M
Credentials:ATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 W MAIN ST APT 404
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-2223
Mailing Address - Country:US
Mailing Address - Phone:908-625-5320
Mailing Address - Fax:
Practice Address - Street 1:74 W MAIN ST APT 404
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2223
Practice Address - Country:US
Practice Address - Phone:908-625-5320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program