Healthcare Provider Details

I. General information

NPI: 1477611572
Provider Name (Legal Business Name): JOHN MICHAEL MIGOTSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 06/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E 67TH ST SUITE 1A
NEW YORK NY
10065-5990
US

IV. Provider business mailing address

115 E 67TH ST SUITE 1A
NEW YORK NY
10065-5990
US

V. Phone/Fax

Practice location:
  • Phone: 212-725-0123
  • Fax: 212-725-3738
Mailing address:
  • Phone: 212-725-0123
  • Fax: 212-725-3738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number193913-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: