Provider Demographics
NPI:1285765586
Name:TRIFARO, MICHAEL D (MSPT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:TRIFARO
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2749 HYLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-4656
Mailing Address - Country:US
Mailing Address - Phone:718-979-7588
Mailing Address - Fax:718-979-7782
Practice Address - Street 1:2749 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-4656
Practice Address - Country:US
Practice Address - Phone:718-979-7588
Practice Address - Fax:718-979-7782
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0150681225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist