Provider Demographics
NPI:1376649806
Name:MYKOFF, DAVID JONAH (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JONAH
Last Name:MYKOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 MARCUS AVE
Mailing Address - Street 2:SUITE 265S
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-2061
Mailing Address - Country:US
Mailing Address - Phone:516-222-2022
Mailing Address - Fax:516-222-8475
Practice Address - Street 1:1300 UNION TPKE
Practice Address - Street 2:SUITE 301
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1764
Practice Address - Country:US
Practice Address - Phone:516-354-8686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY083971207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD83478Medicare UPIN
NY147571Medicare ID - Type Unspecified