Provider Demographics
NPI:1699721126
Name:MISKOVITZ, PAUL FREDERICK (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:FREDERICK
Last Name:MISKOVITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:PAUL
Other - Middle Name:
Other - Last Name:MISKOVITZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:235 EAST 67TH STREET
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065
Mailing Address - Country:US
Mailing Address - Phone:212-717-4966
Mailing Address - Fax:212-717-4970
Practice Address - Street 1:235 EAST 67TH STREET
Practice Address - Street 2:SUITE 203
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065
Practice Address - Country:US
Practice Address - Phone:212-717-4966
Practice Address - Fax:212-717-4970
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127336207RG0100X, 207RI0008X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB11755Medicare UPIN