Provider Demographics
NPI:1407932239
Name:RISMAN, MIKHAIL P (MD)
Entity Type:Individual
Prefix:DR
First Name:MIKHAIL
Middle Name:P
Last Name:RISMAN
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 1:1021 AVENUE Z
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5105
Mailing Address - Country:US
Mailing Address - Phone:718-769-7191
Mailing Address - Fax:718-769-9075
Practice Address - Street 1:1021 AVENUE Z
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5105
Practice Address - Country:US
Practice Address - Phone:718-769-7191
Practice Address - Fax:718-769-9075
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY158905207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00840446Medicaid