Provider Demographics
NPI:1174587786
Name:ERRICO, MICHAEL J (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:ERRICO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:585 PLANDOME RD
Mailing Address - Street 2:STE 104C
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-1971
Mailing Address - Country:US
Mailing Address - Phone:516-627-4242
Mailing Address - Fax:516-627-5460
Practice Address - Street 1:585 PLANDOME RD
Practice Address - Street 2:STE 104C
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-1971
Practice Address - Country:US
Practice Address - Phone:516-627-4242
Practice Address - Fax:516-627-5460
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY098694207X00000X
CAG21138207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400136576Medicare PIN