1124481759 NPI number — DR. MICHAEL PETER CATANZARO D.O.

Table of content: DR. MICHAEL PETER CATANZARO D.O. (NPI 1124481759)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124481759 NPI number — DR. MICHAEL PETER CATANZARO D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CATANZARO
Provider First Name:
MICHAEL
Provider Middle Name:
PETER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124481759
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
04/10/2018
NPI Reactivation Date:
04/21/2018

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
290 OLD COUNTRY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINEOLA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11501-4137
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
151-666-3033
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 WOODS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VALHALLA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10595-1530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-493-7000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/31/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: 308946 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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