Basic Information
| Provider Information | |||||||||
| NPI: | 1215048822 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOKRZYCKI | ||||||||
| FirstName: | MICHELE | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD, MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 510 E 80TH ST | ||||||||
| Address2: | APT 11D | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100750719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2124230239 | ||||||||
| FaxNumber: | 7186528384 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 E 210TH ST | ||||||||
| Address2: | MONTEFIORE MEDICAL CENTER | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104672401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189205442 | ||||||||
| FaxNumber: | 7186528384 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 12/14/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 189085 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 01399742 | 05 | NY | MEDICAID |