Provider Demographics
NPI:1770579062
Name:FUKS, MIKHAIL ABRAMOVICH (MD)
Entity type:Individual
Prefix:
First Name:MIKHAIL
Middle Name:ABRAMOVICH
Last Name:FUKS
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 1:150 BROADWAY
Mailing Address - Street 2:SUITE 714
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-4381
Mailing Address - Country:US
Mailing Address - Phone:212-964-5555
Mailing Address - Fax:212-964-0474
Practice Address - Street 1:150 BROADWAY
Practice Address - Street 2:SUITE 714
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4381
Practice Address - Country:US
Practice Address - Phone:212-964-5555
Practice Address - Fax:212-964-0474
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207032207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01764112Medicaid
NY689823Medicare ID - Type Unspecified
G52595Medicare UPIN