Provider Demographics
NPI:1811295082
Name:CENDOMA, MICHAEL JAMES (ATC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JAMES
Last Name:CENDOMA
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 1:30 COMMERCIAL AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LIVONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14487
Mailing Address - Country:US
Mailing Address - Phone:585-346-0240
Mailing Address - Fax:585-346-9764
Practice Address - Street 1:30 COMMERCIAL AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:LIVONIA
Practice Address - State:NY
Practice Address - Zip Code:14487
Practice Address - Country:US
Practice Address - Phone:585-346-0240
Practice Address - Fax:585-346-9764
Is Sole Proprietor?:No
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001893174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist