Provider Demographics
NPI:1316976418
Name:SARACENO, MICHAEL (OTR/L, CHT)
Entity type:Individual
Prefix:PROF
First Name:MICHAEL
Middle Name:
Last Name:SARACENO
Suffix:
Gender:M
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 176TH AVENUE CIR
Mailing Address - Street 2:
Mailing Address - City:REDINGTON SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33708-1225
Mailing Address - Country:US
Mailing Address - Phone:917-698-7584
Mailing Address - Fax:
Practice Address - Street 1:2372 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6607
Practice Address - Country:US
Practice Address - Phone:718-698-9800
Practice Address - Fax:718-698-9820
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2020-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0090981225X00000X, 225XH1200X, 225XN1300X
FLOT19566225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY20022047OtherUNITED HEALTHCARE
NY009098OtherHIP
NY1699738OtherGHI
NY7070452OtherAETNA
NYP2739398OtherOXFORD
NYQS7731OtherBLUECROSS BLUE SHIELD
NY7070452OtherAETNA