Provider Demographics
NPI:1356746705
Name:STELLA, MICHAEL (ATC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:STELLA
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ROBBINS LN
Mailing Address - Street 2:SUITE D-2
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2365
Mailing Address - Country:US
Mailing Address - Phone:516-802-0152
Mailing Address - Fax:
Practice Address - Street 1:200 ROBBINS LN
Practice Address - Street 2:SUITE D-2
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-2365
Practice Address - Country:US
Practice Address - Phone:516-802-0152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002122-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer