Provider Demographics
NPI:1609962224
Name:BRUNETTI, MICHAEL J (DPM)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:BRUNETTI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 EAST 75TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3119
Mailing Address - Country:US
Mailing Address - Phone:212-534-9393
Mailing Address - Fax:212-534-9397
Practice Address - Street 1:305 EAST 86TH STREET
Practice Address - Street 2:SUITE 1GW
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-4702
Practice Address - Country:US
Practice Address - Phone:212-534-9393
Practice Address - Fax:212-534-9397
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005063-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP60811Medicare PIN
NYU42708Medicare UPIN