Provider Demographics
NPI:1124241260
Name:MIRABELLA, MICHAEL RICHARD (MS, ATC, CSCS)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:RICHARD
Last Name:MIRABELLA
Suffix:
Gender:M
Credentials:MS, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 TODD HILL RD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-3923
Mailing Address - Country:US
Mailing Address - Phone:845-473-4169
Mailing Address - Fax:
Practice Address - Street 1:550 NORTH ST
Practice Address - Street 2:DEPARTMENT OF ATHLETICS
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-3004
Practice Address - Country:US
Practice Address - Phone:914-422-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0008602255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer