Basic Information
| Provider Information | |||||||||
| NPI: | 1972811628 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FARRELL | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | M.D., D.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 462 GRIDER ST | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142153098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7169616091 | ||||||||
| FaxNumber: | 7169616935 | ||||||||
| Practice Location | |||||||||
| Address1: | 3471 FIFTH AVE | ||||||||
| Address2: | SUITE 402 KAUFMAN MEDICAL BUILDING | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028778278 | ||||||||
| FaxNumber: | 2028776292 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2010 | ||||||||
| LastUpdateDate: | 06/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 011927 | NY | N | Chiropractic Providers | Chiropractor | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208VP0014X | 317252-01 | NY | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
No ID Information.