Provider Demographics
NPI:1598209173
Name:MICHELLI, DINO
Entity Type:Individual
Prefix:
First Name:DINO
Middle Name:
Last Name:MICHELLI
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 1:928 N PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-2840
Mailing Address - Country:US
Mailing Address - Phone:516-941-7762
Mailing Address - Fax:
Practice Address - Street 1:300 GARDEN CITY PLAZA, STE 350
Practice Address - Street 2:KIDZ THERAPY/ GAYLE E. KLIGMAN THERAPEUTIC RESOURCES
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530
Practice Address - Country:US
Practice Address - Phone:516-747-9030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2545286174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist