Provider Demographics
NPI:1104804947
Name:MYCEK, JOHN A (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:MYCEK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:99 E STATE ST
Mailing Address - Street 2:PO BOX 1250
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-1203
Mailing Address - Country:US
Mailing Address - Phone:518-775-4360
Mailing Address - Fax:518-773-5237
Practice Address - Street 1:99 E STATE ST
Practice Address - Street 2:MAB SUITE 101
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078-1203
Practice Address - Country:US
Practice Address - Phone:518-775-4360
Practice Address - Fax:518-773-5237
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2015-01-21
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Provider Licenses
StateLicense IDTaxonomies
NY140839207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00544225Medicaid
NYJ400046373Medicare PIN
NY00544225Medicaid