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| Type | Legal entity | [sources] | |||
|---|---|---|---|---|---|
| Name | TYSHKOV MICHAEL · TYSHKOV, MICHAEL · TYSHOV, MICHAEL | [sources] | |||
| Legal form | not available | [sources] | |||
| Country | United States | [sources] | |||
| ID Number | 00180877 | [sources] | |||
| NPI | 1902882038 | [sources] | |||
| Sector | MD · Physician | [sources] | |||
| Status | not available | [sources] | |||
| Address | 87 SHREWSBURY DIRVE, LIVINGSTON, NJ 07039 · 87 SHREWSBURY DRIVE, LIVINGSTON, NJ 07039 | [sources] | |||
| Last change | Last processed | First seen | |||
Medical providers disqualified from participating in New Jersey State's Medicaid program.
United States · OIFP
Medical providers deemed ineligible to participate in New York State's Medicaid program.
United States · OMIG
us-mednj-a6f4fb9429fc545566771ce3b378878134b8b747 · us-mednj-6465a3913c0ab8aeb9f7c0926ce2f632bf2899d8 · us-medny-28801e09aa0435d291f5630468c770f9f0948d26For experts: raw data explorer
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| Sanctions | |||||
|---|---|---|---|---|---|
| Country | Authority | Program | Start date | End date | |
| United States | New Jersey Office of the State Comptroller | - | |||
| Address | ||
|---|---|---|
| Full address | Country | |
| 87 SHREWSBURY DIRVE, LIVINGSTON, NJ 07039 | United States | |
| United States | New York State Office of the Medicaid Inspector General | - | - |
| United States | New Jersey Office of the State Comptroller | - | - |
| 87 SHREWSBURY DRIVE, LIVINGSTON, NJ 07039 | United States |