Provider Demographics
NPI:1598997488
Name:MICCOLI, JOSEPH T (RPA-C)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:T
Last Name:MICCOLI
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:215 ROCKAWAY TPKE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1216
Mailing Address - Country:US
Mailing Address - Phone:516-374-5024
Mailing Address - Fax:516-374-5816
Practice Address - Street 1:215 ROCKAWAY TPKE
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-1216
Practice Address - Country:US
Practice Address - Phone:516-374-5024
Practice Address - Fax:516-374-5816
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY013446363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical