Provider Demographics
NPI:1912064452
Name:CORMICAN, MICHAEL (PT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:CORMICAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14 HEWITT RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-1630
Mailing Address - Country:US
Mailing Address - Phone:516-678-1811
Mailing Address - Fax:516-678-2442
Practice Address - Street 1:303 PARK AVE S
Practice Address - Street 2:#1243
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-3601
Practice Address - Country:US
Practice Address - Phone:646-742-0165
Practice Address - Fax:646-742-0462
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY012035225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist