Provider Demographics
NPI:1699882399
Name:FUKSHANSKY, MIKHAIL (MD)
Entity type:Individual
Prefix:
First Name:MIKHAIL
Middle Name:
Last Name:FUKSHANSKY
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 1:1009 BRIGHTON BEACH AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5621
Mailing Address - Country:US
Mailing Address - Phone:718-975-8500
Mailing Address - Fax:718-975-8502
Practice Address - Street 1:1009 BRIGHTON BEACH AVE STE 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5621
Practice Address - Country:US
Practice Address - Phone:718-975-8500
Practice Address - Fax:718-975-8502
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0081208VP0014X, 208100000X
NY2222072081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172626701Medicaid
TX172626701Medicaid
TX172626701Medicaid