Provider Demographics
NPI:1437821113
Name:SAMMARITANO, MICHELE ALBERTO
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:ALBERTO
Last Name:SAMMARITANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 BRENTWOOD ST
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-2009
Mailing Address - Country:US
Mailing Address - Phone:718-377-5000
Mailing Address - Fax:
Practice Address - Street 1:90 BRENTWOOD ST
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-2009
Practice Address - Country:US
Practice Address - Phone:718-377-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012973225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant