Provider Demographics
NPI:1699834119
Name:PAOLUCCI, MICHELE M (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:M
Last Name:PAOLUCCI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 OLD ARMY RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-2645
Mailing Address - Country:US
Mailing Address - Phone:212-423-6796
Mailing Address - Fax:212-423-8121
Practice Address - Street 1:1901 1ST AVE RM 4B5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-7404
Practice Address - Country:US
Practice Address - Phone:212-423-6796
Practice Address - Fax:212-423-8121
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184473174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist