Provider Demographics
NPI:1093154114
Name:FIKSMAN, MIKHAIL (RN)
Entity Type:Individual
Prefix:MR
First Name:MIKHAIL
Middle Name:
Last Name:FIKSMAN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 SEAGATE CT
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4761
Mailing Address - Country:US
Mailing Address - Phone:646-642-8478
Mailing Address - Fax:
Practice Address - Street 1:2076 E 13TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3304
Practice Address - Country:US
Practice Address - Phone:718-382-7901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY667927163WP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0000XNursing Service ProvidersRegistered NursePain Management