Provider Demographics
NPI:1578509923
Name:NAIMAN MICHAELS, ELLEN GAIL (PT)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:GAIL
Last Name:NAIMAN MICHAELS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:GAIL
Other - Last Name:NAIMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4 WEBER AVE
Mailing Address - Street 2:
Mailing Address - City:MALVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11565-1742
Mailing Address - Country:US
Mailing Address - Phone:516-599-3999
Mailing Address - Fax:
Practice Address - Street 1:4 WEBER AVE
Practice Address - Street 2:
Practice Address - City:MALVERNE
Practice Address - State:NY
Practice Address - Zip Code:11565-1742
Practice Address - Country:US
Practice Address - Phone:516-599-3999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014610-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ02421Medicare UPIN