1639624919 NPI number — DR. MICHAEL PICCIRILLO D.C.

Table of content: DR. MICHAEL PICCIRILLO D.C. (NPI 1639624919)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639624919 NPI number — DR. MICHAEL PICCIRILLO D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PICCIRILLO
Provider First Name:
MICHAEL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
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:
1639624919
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 S FEDERAL HWY STE 451
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POMPANO BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33062-7525
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
754-205-6865
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2390 NE 186TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33180-2907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-932-2202
Provider Business Practice Location Address Fax Number:
754-206-1958
Provider Enumeration Date:
08/17/2016

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: 111NS0005X , with the licence number:  CH11903 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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