Provider Demographics
NPI:1982788824
Name:CELOTTI, MICHAEL J (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:CELOTTI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CAREY RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-7880
Mailing Address - Country:US
Mailing Address - Phone:518-761-0300
Mailing Address - Fax:518-824-2388
Practice Address - Street 1:33 TOM PHELPS LN
Practice Address - Street 2:
Practice Address - City:MINEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12956-0480
Practice Address - Country:US
Practice Address - Phone:518-942-7123
Practice Address - Fax:518-942-7041
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233197208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02572801Medicaid
NYJ400034306Medicare PIN