Basic Information
| Provider Information | |||||||||
| NPI: | 1376830505 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VISCUSO | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | D.P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 755 NEW YORK AVE | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | HUNTINGTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117434240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6313517676 | ||||||||
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| Practice Location | |||||||||
| Address1: | 92 BROADWAY | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | GREENLAWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117401328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312627855 | ||||||||
| FaxNumber: | 6312627854 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2011 | ||||||||
| LastUpdateDate: | 09/27/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 034002 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.