Provider Demographics
NPI:1982697934
Name:POON, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:POON
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 1:70 BOWERY
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4607
Mailing Address - Country:US
Mailing Address - Phone:212-925-4088
Mailing Address - Fax:917-595-5319
Practice Address - Street 1:70 BOWERY
Practice Address - Street 2:SUITE 303
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4607
Practice Address - Country:US
Practice Address - Phone:212-925-4088
Practice Address - Fax:917-595-5319
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175234207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01527682Medicaid
NY01527682Medicaid
NYE94874Medicare UPIN