Provider Demographics
NPI:1477608313
Name:MAYKISH, MICHAEL (PT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:MAYKISH
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 EAGLE ROCK AVENUE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:ROSELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07068-1503
Mailing Address - Country:US
Mailing Address - Phone:973-226-1655
Mailing Address - Fax:973-226-4502
Practice Address - Street 1:2 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:PLAINSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08536-2191
Practice Address - Country:US
Practice Address - Phone:877-407-3422
Practice Address - Fax:877-407-4329
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
40QA00236700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P37633Medicare UPIN
050102Medicare ID - Type UnspecifiedP25