Provider Demographics
NPI:1972668747
Name:VIKSMAN, MICHAEL Y (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:Y
Last Name:VIKSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 CRAIG RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-8787
Mailing Address - Country:US
Mailing Address - Phone:732-683-1071
Mailing Address - Fax:732-683-1070
Practice Address - Street 1:717 N BEERS ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1524
Practice Address - Country:US
Practice Address - Phone:732-739-0660
Practice Address - Fax:732-739-1406
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA05773700207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6520600Medicaid
657056PSRMedicare ID - Type Unspecified
NJ6520600Medicaid