Healthcare Provider Details

I. General information

NPI: 1093347270
Provider Name (Legal Business Name): JOSEPH MICHALISIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 10/02/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 WEST 36TH STREET, 7TH FLOOR
NEW YORK NY
10018
US

IV. Provider business mailing address

525 WEST 36TH STREET, 7TH FLOOR
NEW YORK NY
10018
US

V. Phone/Fax

Practice location:
  • Phone: 646-429-0018
  • Fax:
Mailing address:
  • Phone: 646-429-0018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number323898
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: