Provider Demographics
NPI:1316027816
Name:PRYSTOWSKY, MICHAEL B (MD,PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:B
Last Name:PRYSTOWSKY
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 STERLING RD
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-1321
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:718-882-8461
Practice Address - Street 1:MMC - DEPT. OF PATHOLOGY
Practice Address - Street 2:111 E. 210TH ST., GOLD ZONE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-920-2456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197778207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine