Provider Demographics
NPI:1245235282
Name:ZYCHOWICZ, MICHAEL
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:ZYCHOWICZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 BLOOMING GROVE TPKE
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-7769
Mailing Address - Country:US
Mailing Address - Phone:845-561-8060
Mailing Address - Fax:845-561-8523
Practice Address - Street 1:219 BLOOMING GROVE TPKE
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-7769
Practice Address - Country:US
Practice Address - Phone:845-561-8060
Practice Address - Fax:845-561-8523
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3021901174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY368063OtherMVP PROVIDER #
NY02188512Medicaid
NYS50908Medicare UPIN
NY02188512Medicaid