Provider Demographics
NPI:1841361847
Name:MYSSIOREK, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MYSSIOREK
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 1:160 E 34TH STREET
Mailing Address - Street 2:NEW YORK UNIVERSITY CLINICAL CANCER CENTER
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4744
Mailing Address - Country:US
Mailing Address - Phone:212-731-6085
Mailing Address - Fax:212-731-5502
Practice Address - Street 1:160 E 34TH ST
Practice Address - Street 2:9TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4744
Practice Address - Country:US
Practice Address - Phone:212-731-6085
Practice Address - Fax:212-731-5502
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147877207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY67D27ANP21Medicare PIN