Individual
DR. MICHAEL TYSHKOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
584 FOREST AVE, STATEN ISLAND, NY 10310-2512
(718) 226-5619
(718) 226-5620
Mailing address
1 EDGEWATER ST, 6TH FL. PAYER RELATIONS, STATEN ISLAND, NY 10305-4900
(718) 226-1008
(718) 226-1039
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
180877
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01268262
—
NY
05
—
5341400
—
NJ
Enumeration date
12/20/2005
Last updated
12/31/2008
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