Provider Demographics
NPI:1548720030
Name:EPIFANIA, MICHAEL (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:EPIFANIA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 E MAIN ST BLDG C
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2847
Mailing Address - Country:US
Mailing Address - Phone:631-216-9253
Mailing Address - Fax:631-216-9254
Practice Address - Street 1:267 E MAIN ST BLDG C
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2847
Practice Address - Country:US
Practice Address - Phone:631-216-9253
Practice Address - Fax:631-216-9254
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY317788207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1548720030Medicaid