Provider Demographics
NPI:1558436972
Name:MICHALOWICZ, RICHARD FRANCIS (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:FRANCIS
Last Name:MICHALOWICZ
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 1:21 SHORE LANE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706
Mailing Address - Country:US
Mailing Address - Phone:631-665-7378
Mailing Address - Fax:631-665-3190
Practice Address - Street 1:21 SHORE LANE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706
Practice Address - Country:US
Practice Address - Phone:631-665-7378
Practice Address - Fax:631-665-3190
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160797207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00872660Medicaid
NYA62500Medicare UPIN
NY00872660Medicaid