Michael Joseph Canzoniero, PH.D
Individual provider Active NPI Psychologist · Shoreham, NY
NPI 1225129307 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1225129307
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- 006227-1 (NY)
- Practice address
- 4 Salty Way
Shoreham, NY 11786-1146 - Phone
- (631) 821-2773
- Fax
- (631) 821-2773
- NPI assigned
- Sep 27, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 006227-1 | NY | MD | Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 006227-1 | NY | Yes |
Addresses
Primary practice location
4 Salty Way
Shoreham, NY 11786-1146
Mailing address
4 Salty Way
Shoreham, NY 11786-1146
Phone (631) 821-2773
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6894081 | Other | NY | VALUE OPTIONS PROVIDER ID |
| 4348117 | Other | NY | AETNA PROVIDER ID |
Other providers in Shoreham, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.