Provider Demographics
NPI:1407842719
Name:DUFFE, MICHAEL W (RPAC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:W
Last Name:DUFFE
Suffix:
Gender:M
Credentials:RPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 MARCUS AVE
Mailing Address - Street 2:STE 170 WEST NEW YORK SPINE SPECIALISTS
Mailing Address - City:LAKE SUCCESS
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1035
Mailing Address - Country:US
Mailing Address - Phone:516-355-0111
Mailing Address - Fax:516-355-5457
Practice Address - Street 1:2001 MARCUS AVE
Practice Address - Street 2:STE 170
Practice Address - City:LAKE SUCCESS
Practice Address - State:NY
Practice Address - Zip Code:11042-1011
Practice Address - Country:US
Practice Address - Phone:516-355-0111
Practice Address - Fax:516-355-5457
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007224363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P10704Medicare UPIN
MD00F43620Medicare ID - Type Unspecified