Provider Demographics
NPI:1417948324
Name:FARELLA-ACCURSO, MICHELLE L (PT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:FARELLA-ACCURSO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:L
Other - Last Name:FARELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:NORTHERN BLVD
Mailing Address - Street 2:ACADEMIC HEALTH CARE CENTER, NY INSTITUTE OF TECHNOLOGY
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568-8000
Mailing Address - Country:US
Mailing Address - Phone:516-686-1300
Mailing Address - Fax:516-686-7890
Practice Address - Street 1:NORTHERN BLVD
Practice Address - Street 2:ACADEMIC HEALTH CARE CENTER, NY INSTITUTE OF TECHNOLOGY
Practice Address - City:OLD WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11568-8000
Practice Address - Country:US
Practice Address - Phone:516-686-1300
Practice Address - Fax:516-686-7890
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20151-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1417948324OtherNPI NUMBER
NY1821048612OtherGROUP NPI NUMBER
NY1821048612OtherGROUP NPI NUMBER