Michael Tyshkov, MD

Primary specialty

Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X

License

180877 Issued in NY

Practice address

584 Forest Ave
Staten Island, NY 10310-2512

Phone

(718) 226-5619

Fax

(718) 226-5620

NPI assigned

Dec 20, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pediatric Pulmonary Associates of Central New Jersey

  • Pediatric Pulmonology Physician
  • Summit, NJ
  • NPI 1376739672
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1135036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1230681600000",
    "number": "1902882038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 EDGEWATER ST",
            "address_2": "6TH FL. PAYER RELATIONS",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103054900",
            "telephone_number": "718-226-1008",
            "fax_number": "718-226-1039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "584 FOREST AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103102512",
            "telephone_number": "718-226-5619",
            "fax_number": "718-226-5620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TYSHKOV",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-20",
        "last_updated": "2008-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "NY",
            "license": "180877",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01268262",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5341400",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Priya Tyagi
• Veronika Tyatina, PHARMD
• Susan Merle Tyburczy, PH.D.
• Edison Tyli, NP
• Tabetha Tanae Tyndale, NURSE PRACTITIONER
• Christina Michelle Ucelli, MA
• Chukwukelue Nwabueze Uchefuna, MD
• Salvatore Anthony Uggiano III, PA
• Derek F Ugwendum, MD
• Oge Margret Ukatu

• Pediatric Gastroenterology Physician in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Pediatric Gastroenterology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.