Basic Information
| Provider Information | |||||||||
| NPI: | 1811910425 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MIKA | ||||||||
| FirstName: | PHILIP | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2125 RIVER RD | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | SCHENECTADY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 123091135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5183828350 | ||||||||
| FaxNumber: | 5183820345 | ||||||||
| Practice Location | |||||||||
| Address1: | 2125 RIVER RD | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | SCHENECTADY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 123091135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5183828350 | ||||||||
| FaxNumber: | 5183820345 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 01/24/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | 115728 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 070119000062 | 01 | NY | FIDELIS - ENDOCRINOLOGY | OTHER | 4625730 | 01 | NY | AETNA | OTHER | 47346 | 01 | NY | GHI/HMO | OTHER | 28N081 | 01 | NY | EMPIRE BC | OTHER | 200097 | 01 | NY | SENIOR WHOLE HEALTH | OTHER | 000408519001 | 01 | NY | BSNENY | OTHER | 11120 | 01 | NY | MVP | OTHER | 28102 | 01 | NY | MVP | OTHER | 00527477 | 05 | NY | MEDICAID | 041208000020 | 01 | NY | FIDELIS - INT MEDICINE | OTHER | 10001371 | 01 | NY | CDPHP | OTHER |