Individual provider Active NPI

Micheal Cannizzaro, M.D

  • Internal Medicine Physician
  • New York, NY
National Provider Identifier
1588673792
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
190322 Issued in NY
Practice address
645 10TH Ave
New York, NY 10036-2904
Phone
(212) 265-4500
Fax
(212) 265-6565
NPI assigned
Aug 5, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 190322 NY Primary

Addresses

Primary practice location

645 10TH Ave
New York, NY 10036-2904

Mailing address

645 10TH Ave
New York, NY 10036-2904
Phone (212) 265-4500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
190322NYMDInternal Medicine Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1588673792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "645 10TH AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100362904",
            "telephone_number": "212-265-4500",
            "fax_number": "212-265-6565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "645 10TH AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100362904",
            "telephone_number": "212-265-4500",
            "fax_number": "212-265-6565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNIZZARO",
        "first_name": "MICHEAL",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "190322",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.