Healthcare Provider Details

I. General information

NPI: 1942260419
Provider Name (Legal Business Name): MICHAEL Y MIZHIRITSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 E 67TH ST GROUND LEVEL
NEW YORK NY
10065-6136
US

IV. Provider business mailing address

1198 3RD AVE
NEW YORK NY
10021-5102
US

V. Phone/Fax

Practice location:
  • Phone: 212-759-4553
  • Fax: 212-486-8334
Mailing address:
  • Phone: 212-759-4553
  • Fax: 212-486-8334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number200093
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: