Provider Demographics
NPI:1316908692
Name:ALYSKEWYCZ, MYKOLA (MD)
Entity type:Individual
Prefix:
First Name:MYKOLA
Middle Name:
Last Name:ALYSKEWYCZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MEDICAL PLZ
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2193
Mailing Address - Country:US
Mailing Address - Phone:516-676-2270
Mailing Address - Fax:516-676-5498
Practice Address - Street 1:10 MEDICAL PLZ
Practice Address - Street 2:SUITE 101
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2193
Practice Address - Country:US
Practice Address - Phone:516-676-2270
Practice Address - Fax:516-676-5498
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY197665208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01524730Medicaid
NY01K771Medicare PIN
NY01524730Medicaid