Provider Demographics
NPI:1467600023
Name:MICHALOS, JOHN (MS ED)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:MICHALOS
Suffix:
Gender:M
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 GOTHAM CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT SINAI
Mailing Address - State:NY
Mailing Address - Zip Code:11766-2354
Mailing Address - Country:US
Mailing Address - Phone:631-790-2500
Mailing Address - Fax:718-739-5137
Practice Address - Street 1:2 GOTHAM CT
Practice Address - Street 2:
Practice Address - City:MOUNT SINAI
Practice Address - State:NY
Practice Address - Zip Code:11766-2354
Practice Address - Country:US
Practice Address - Phone:631-790-2500
Practice Address - Fax:718-739-5137
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY089548851171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor