Provider Demographics
NPI:1184694614
Name:PESCI, MICHAEL P (PA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:PESCI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1001 W FAYETTE ST
Mailing Address - Street 2:STE 400
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-2859
Mailing Address - Country:US
Mailing Address - Phone:315-472-1488
Mailing Address - Fax:315-472-8060
Practice Address - Street 1:4631 ONONDAGA BLVD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13219-3301
Practice Address - Country:US
Practice Address - Phone:315-487-4844
Practice Address - Fax:315-487-4153
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY002546363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR55790Medicare UPIN
NYBB8437Medicare PIN
NY970023514Medicare PIN