Provider Demographics
NPI:1669573879
Name:DEMEO, MICHELLE REGINA (PA)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:REGINA
Last Name:DEMEO
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:170 EAST 77TH STREET
Mailing Address - Street 2:C/O MANHATTAN ORTHOPAEDICS, 7TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075
Mailing Address - Country:US
Mailing Address - Phone:212-744-8114
Mailing Address - Fax:
Practice Address - Street 1:130 EAST 77TH STREET
Practice Address - Street 2:C/O MANHATTAN ORTHOPAEDICS, 7TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1851
Practice Address - Country:US
Practice Address - Phone:212-744-8114
Practice Address - Fax:212-472-5624
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2010-10-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY11135363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWNW221Medicare PIN
NYDH0034Medicare PIN
NY6176LNW221Medicare PIN