Provider Demographics
NPI:1447421821
Name:MISHAIL, ALEK (MD)
Entity Type:Individual
Prefix:
First Name:ALEK
Middle Name:
Last Name:MISHAIL
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 1:9971 65TH RD
Mailing Address - Street 2:FL 1
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3654
Mailing Address - Country:US
Mailing Address - Phone:718-606-0909
Mailing Address - Fax:718-374-6999
Practice Address - Street 1:9971 65TH RD FL 1
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3654
Practice Address - Country:US
Practice Address - Phone:718-606-0909
Practice Address - Fax:718-374-6999
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2020-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243000208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03225867Medicaid
NYG100045367Medicare PIN