Individual provider Active NPI

Alexander Yakov Factourovich, MD

  • Psychiatry Physician
  • Binghamton, NY
National Provider Identifier
1265483481
Registry record updated Dec 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
233180 Issued in NY
Practice address
10-42 Mitchell Ave
Binghamton, NY 13903-1617
Phone
(607) 762-2990
NPI assigned
May 12, 2006
Last updated
Dec 24, 2015By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 24, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 233180 NY Primary

Addresses

Primary practice location

10-42 Mitchell Ave
Binghamton, NY 13903-1617

Mailing address

43 San Marco Dr
Johnson City, NY 13790-5017
Phone (607) 729-7955

Other identifiers 1

IdentifierTypeStateIssuer
02601632MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041116000700 NY Practitioner - Psychiatry 4082678420 Reassigns benefits to 1 organization
Practice locations: Binghamton, NY

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 1974
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

10 Mitchell Ave
Suite 24
Binghamton, NY 13903-1617
Phone (607) 762-2990

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
233180NYMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Broome County Mental Health Department PastSince Jan 1, 2001 Accepting new patients
Broome County Past Accepting new patients

Organizations & group practices 3

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

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450915200000",
    "number": "1265483481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43 SAN MARCO DR",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "137905017",
            "telephone_number": "607-729-7955",
            "fax_number": "607-729-7955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10-42 MITCHELL AVE",
            "city": "BINGHAMTON",
            "state": "NY",
            "postal_code": "139031617",
            "telephone_number": "607-762-2990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FACTOUROVICH",
        "first_name": "ALEXANDER",
        "middle_name": "YAKOV",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-12",
        "last_updated": "2015-12-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "233180",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02601632",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Binghamton, NY

Sources for this page

Verify at the official NPI Registry.