Provider Demographics
NPI:1871557538
Name:MIGDALOVICH, ARKADY (PT)
Entity type:Individual
Prefix:
First Name:ARKADY
Middle Name:
Last Name:MIGDALOVICH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-1421
Mailing Address - Country:US
Mailing Address - Phone:917-597-2172
Mailing Address - Fax:718-980-3619
Practice Address - Street 1:8712 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-5110
Practice Address - Country:US
Practice Address - Phone:718-680-1600
Practice Address - Fax:718-680-4473
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017757208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11-3552139OtherMULTIPLAN
NY11-3552139OtherUNITED HEALTH CARE
NY11-3552139Other1199 NBF
NY017757OtherHIP
NYQB6251OtherEMPIRE BC/BS
NYN84089OtherHEALTH NET
NY02019583Medicaid
NY6699137OtherGHI
NY000160820201OtherHEALTH PLUS
NY017757OtherHIP
NY11-3552139OtherMULTIPLAN