Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | X38986 | NY |
NPI | 1467645226 |
---|---|
Provider Name | Dr. Michael Cirisano |
First Address | Franklin Square, NY 11010-2846 |
Second Address | Franklin Square, NY 11010-2846 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2007 |
Last Update Date | 23/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T52607 | (02) | NY |