Otar Michael Taktakishvili, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

054323 Issued in CT

Practice address

259 1St St
Emergency Department
Mineola, NY 11501-3957

Phone

(516) 663-2727

Fax

(516) 663-2727

NPI assigned

May 20, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Bridgeport Hospital

  • General Acute Care Hospital
  • Bridgeport, CT
  • NPI 1649260845
  Medicare reassignment NPD
• Danbury Hospital

  • General Acute Care Hospital
  • Danbury, CT
  • NPI 1548293343
  Medicare reassignment NPD
• Norwalk Hospital Association

  • General Acute Care Hospital
  • Norwalk, CT
  • NPI 1427041581
  Medicare reassignment NPD
• Bridgeport Hospital

  • General Acute Care Hospital
  • Milford, CT
  • NPI 1891376810
  NPD
• Danbury Hospital

  • General Acute Care Hospital
  • New Milford, CT
  • NPI 1619938016

  Emergency Medicine

  NPD
• Norwalk Hospital Association

  • General Acute Care Hospital
  • Norwalk, CT
  • NPI 1649263880
  NPD
• Nuvance Health Medical Practice CT, Inc.

  • Internal Medicine Physician
  • Danbury, CT
  • NPI 1407898117
  NPD

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

{
    "created_epoch": "1211241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439942400000",
    "number": "1346407129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "259 1ST ST",
            "address_2": "EMERGENCY DEPARTMENT",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115013957",
            "telephone_number": "516-663-2727",
            "fax_number": "516-663-2727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "259 1ST ST",
            "address_2": "EMERGENCY DEPARTMENT",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115013957",
            "telephone_number": "516-663-2727",
            "fax_number": "516-663-2727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAKTAKISHVILI",
        "first_name": "OTAR",
        "middle_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-20",
        "last_updated": "2015-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CT",
            "license": "054323",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "260699",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mona L Sussman, PA
• Abo Suyonov, PA
• Jane Swedler, M.D.
• Alzbeta Sykora, MD
• Patricia Tafuro, D.O.
• Eric Tam, MD
• Vianka Tamburro
• Marie Cris Bohol Tamesis, M.D.
• Jessica Tan
• Sally Tan

• Emergency Medicine Physician in Mineola, NY
• Providers in Mineola, NY by specialty
• Emergency Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.