| Doctor Name: | MR. MICHAEL C POLISENO |
| NPI Number: | 1073632956 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | APN |
| License Number: | F302312-1 |
| Business Practice Address: | 2094 Merrick Ave Merrick, NY - 115663147 |
| Business Phone Number: | 5163755904 |
| Business Fax Number: | 5168042784 |
| Mailing Address: | 2094 Merrick Ave, MERRICK |
| State: | NY |
| Postal Code: | 115663147 |
| Phone Number: | 5163755904 |
| Fax Number: | 5168042784 |
| NPI Enumeration Date: | 03/29/2007 |
| NPI Last Update Date: | 08/17/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | F302312-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |