Individual
DR. MICHAEL DAVID KISICKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
312 E 94TH ST, NEW YORK, NY 10128-5604
(212) 423-3000
Mailing address
312 E 94TH ST, NEW YORK, NY 10128-5604
(212) 423-3000
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
328470
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A96472
MEDICAL LICENSE
CA
Enumeration date
05/24/2007
Last updated
09/24/2024
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