Provider Demographics
NPI:1962573220
Name:MIKHAIL, IMAD (MD)
Entity type:Individual
Prefix:
First Name:IMAD
Middle Name:
Last Name:MIKHAIL
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 1:63 MINEOLA AVE
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-2001
Mailing Address - Country:US
Mailing Address - Phone:646-325-3463
Mailing Address - Fax:
Practice Address - Street 1:63 MINEOLA AVE
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-2001
Practice Address - Country:US
Practice Address - Phone:646-325-3463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2410251207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY271SM1OtherNY EMPIRE BCBS
NY02825056Medicaid
NY271SM1OtherNY EMPIRE BCBS
NY02825056Medicaid