Provider Demographics
NPI:1467472712
Name:MICHAEL, JEFFREY J (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:J
Last Name:MICHAEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:530 1ST AVE
Mailing Address - Street 2:SUITE 4B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6402
Mailing Address - Country:US
Mailing Address - Phone:212-263-0705
Mailing Address - Fax:212-263-0704
Practice Address - Street 1:530 1ST AVE
Practice Address - Street 2:SUITE 4B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:212-263-0705
Practice Address - Fax:212-263-0704
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208162207R00000X
NY208162-1207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
133980318-10Other1199
7095355OtherAETNA HMO
7282389OtherCIGNA
0M1298OtherHEALTHNET
133980318OtherMULTIPLAN
NY02287516Medicaid
3399673OtherGHI
133980318OtherEMPIRE UNITED
208162OtherHIP
H58597Medicare UPIN
0M1298OtherHEALTHNET