Provider Demographics
NPI:1538152459
Name:JOSOVITZ, MICHAEL (MD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:JOSOVITZ
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 1:950 44TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-1737
Mailing Address - Country:US
Mailing Address - Phone:718-851-0827
Mailing Address - Fax:718-851-4948
Practice Address - Street 1:950 44TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-1737
Practice Address - Country:US
Practice Address - Phone:718-851-0827
Practice Address - Fax:718-851-4948
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170645207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01023312Medicaid
NY98D511Medicare ID - Type Unspecified
NY01023312Medicaid