Provider Demographics
NPI:1619006715
Name:MICHAEL L. INNERFIELD, M.D., P.C.
Entity Type:Organization
Organization Name:MICHAEL L. INNERFIELD, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:INNERFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:845-553-5050
Mailing Address - Street 1:2 EXECUTIVE BLVD
Mailing Address - Street 2:SUTITE 406
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-4164
Mailing Address - Country:US
Mailing Address - Phone:845-353-5050
Mailing Address - Fax:845-353-1295
Practice Address - Street 1:2 EXECUTIVE BLVD
Practice Address - Street 2:SUTITE 406
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4164
Practice Address - Country:US
Practice Address - Phone:845-353-5050
Practice Address - Fax:845-353-1295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY151314174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01073707Medicaid
NJ178158Medicare ID - Type Unspecified
NY97D991Medicare ID - Type Unspecified