Organization
MICHAEL J DECICCO MD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL J DECICCO MD (OWNER)
(315) 787-5353
Entity
Organization
Contact information
Practice address
200 NORTH ST, SUITE 301, GENEVA, NY 14456-1561
(315) 787-5353
(315) 315-7875
Mailing address
67 KENDALL STREET, SUITE 200, CLIFTON SPRINGS, NY 14432
(315) 462-9482
(315) 462-5438
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
220674
NY
207YP0228X
Pediatric Otolaryngology Physician
220674
NY
207YS0123X
Facial Plastic Surgery Physician
220674
NY
Other
Enumeration date
02/12/2007
Last updated
08/22/2007
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