Provider Demographics
NPI:1952377285
Name:MERLETTI, MICHAEL J (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:MERLETTI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 10TH ST
Mailing Address - Street 2:SUITE 700
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301-1841
Mailing Address - Country:US
Mailing Address - Phone:716-278-4424
Mailing Address - Fax:
Practice Address - Street 1:620 10TH ST
Practice Address - Street 2:SUITE 700
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-1841
Practice Address - Country:US
Practice Address - Phone:716-278-4424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004636213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01205669Medicaid
NY278971Medicare ID - Type Unspecified
NYU20010Medicare UPIN