Provider Demographics
NPI:1972816791
Name:FOX, MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:FOX
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 W 86TH ST
Mailing Address - Street 2:APT. 10D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3615
Mailing Address - Country:US
Mailing Address - Phone:212-580-1789
Mailing Address - Fax:212-580-1970
Practice Address - Street 1:27 W 86TH ST
Practice Address - Street 2:APT. 10D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3615
Practice Address - Country:US
Practice Address - Phone:212-580-1789
Practice Address - Fax:212-580-1970
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8177103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01395326Medicaid