Provider Demographics
NPI:1215344890
Name:FRANCAVIGLIA, MICHELE DENISE
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:DENISE
Last Name:FRANCAVIGLIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 WHITE OAK LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-1945
Mailing Address - Country:US
Mailing Address - Phone:718-356-0622
Mailing Address - Fax:718-356-0622
Practice Address - Street 1:22 WHITE OAK LANE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309
Practice Address - Country:US
Practice Address - Phone:718-614-7471
Practice Address - Fax:718-356-0622
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1839345174400000X
NY526660041174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist