Healthcare Provider Details

I. General information

NPI: 1881854735
Provider Name (Legal Business Name): MICHAEL MIKSA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2008
Last Update Date: 02/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 210TH ST CHILDREN'S HOSPITAL AT MONTEFIORE
BRONX NY
10467-2401
US

IV. Provider business mailing address

111 E 210TH ST CHILDREN'S HOSPITAL AT MONTEFIORE
BRONX NY
10467-2401
US

V. Phone/Fax

Practice location:
  • Phone: 212-810-9986
  • Fax:
Mailing address:
  • Phone: 212-810-9986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number265433
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number265433
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: