Individual
DR. MICHAEL E KISSIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
2797 OCEAN PKWY, BROOKLYN, NY 11235-7861
(718) 332-6025
Mailing address
65 ORIENTAL BLVD, SUITE 12C, BROOKLYN, NY 11235-4945
(718) 332-6025
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
009369
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000207890201
HEALTH PLUS PROV.#
NY
01
—
009369
LICENCE #
NY
05
—
01499105
—
NY
01
—
4571094
AETNA PROV. #
NY
01
—
654049
UHC
NY
01
—
7348273
GHI PROV #
NY
01
—
V41631
BLUE CROSS BLUE SHEILD ID
NY
Enumeration date
11/29/2006
Last updated
05/10/2008
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