Provider Demographics
NPI:1982184578
Name:MACCARRIELLO, MICHAEL (PT,DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MACCARRIELLO
Suffix:
Gender:M
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1243 WOODROW RD STE 321
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-1725
Mailing Address - Country:US
Mailing Address - Phone:718-844-5350
Mailing Address - Fax:718-966-0005
Practice Address - Street 1:1351 FOREST AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302-2049
Practice Address - Country:US
Practice Address - Phone:718-390-0060
Practice Address - Fax:718-390-0067
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043254225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist