Provider Demographics
NPI:1992768303
Name:ACOCELLA, MICHEAL W (BS, PT)
Entity type:Individual
Prefix:MR
First Name:MICHEAL
Middle Name:W
Last Name:ACOCELLA
Suffix:
Gender:M
Credentials:BS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:469 W PUTNAM AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-6060
Mailing Address - Country:US
Mailing Address - Phone:203-869-5546
Mailing Address - Fax:203-629-4836
Practice Address - Street 1:469 W PUTNAM AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6060
Practice Address - Country:US
Practice Address - Phone:203-869-5546
Practice Address - Fax:203-629-4836
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4305214OtherAETNA
CT397526OtherPHCS
CT397526OtherPHCS