Provider Demographics
NPI:1841389608
Name:BYKOFF, GARY IRWIN (MD)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:IRWIN
Last Name:BYKOFF
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 1:281 HARTFORD TPKE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066
Mailing Address - Country:US
Mailing Address - Phone:860-871-8543
Mailing Address - Fax:860-896-1518
Practice Address - Street 1:281 HARTFORD TURNPIKE
Practice Address - Street 2:SUITE 303
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066
Practice Address - Country:US
Practice Address - Phone:860-871-8543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT25799207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010025799CT01OtherBCBS
CT001257997Medicaid
CT025799OtherCTC
B84340Medicare UPIN
CT110001192Medicare ID - Type Unspecified