Provider Demographics
NPI:1679734792
Name:POPIELASKI, MICHELE CHRISTINE (RN,)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:CHRISTINE
Last Name:POPIELASKI
Suffix:
Gender:F
Credentials:RN,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 PATCHOGUE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778-9346
Mailing Address - Country:US
Mailing Address - Phone:631-849-3267
Mailing Address - Fax:
Practice Address - Street 1:68 PATCHOGUE DR
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-9346
Practice Address - Country:US
Practice Address - Phone:631-849-3267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY555931-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY555931-1Medicaid