Provider Demographics
NPI:1508947268
Name:CORTESE, MICHAEL J (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:CORTESE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:9 VISTA BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159-2183
Mailing Address - Country:US
Mailing Address - Phone:518-598-0202
Mailing Address - Fax:518-598-1454
Practice Address - Street 1:9 VISTA BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:SLINGERLANDS
Practice Address - State:NY
Practice Address - Zip Code:12159-2183
Practice Address - Country:US
Practice Address - Phone:518-598-0202
Practice Address - Fax:518-598-1454
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY004035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4167870002Medicare NSC
NYDD4633Medicare UPIN