| Doctor Name: | DR. MICHAEL DISPENZA |
| NPI Number: | 1225192503 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 179288 |
| Business Practice Address: | 6906 Myrtle Ave Glendale, NY - 113857264 |
| Business Phone Number: | 7186288047 |
| Business Fax Number: | 7186285419 |
| Mailing Address: | 6906 Myrtle Ave, GLENDALE |
| State: | NY |
| Postal Code: | 113857264 |
| Phone Number: | 7186288047 |
| Fax Number: | 7186285419 |
| NPI Enumeration Date: | 12/20/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 179288 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |