Provider Demographics
NPI:1477611572
Name:MIGOTSKY, JOHN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:MIGOTSKY
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 1:115 E 67TH ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-5990
Mailing Address - Country:US
Mailing Address - Phone:212-725-0123
Mailing Address - Fax:212-725-3738
Practice Address - Street 1:115 E 67TH ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-5990
Practice Address - Country:US
Practice Address - Phone:212-725-0123
Practice Address - Fax:212-725-3738
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193913-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0595915OtherAETNA
1387641OtherFIRST HEALTH
NY33G501OtherBLUE CROSS
P7527151OtherCIGNA HEALTH PLANS
P416343OtherOXFORD HEALTH PLANS
NY160058887OtherRAILROAD MEDICARE
2C7818OtherHEALTHNET
5057302OtherAETNA
0021716OtherGHI
08738472202OtherPOMCO
NY33G502OtherBLUE CROSS
NY33G503OtherBLUE CROSS
NY33G503Medicare PIN
2C7818OtherHEALTHNET
5057302OtherAETNA
NY33G502OtherBLUE CROSS