Active NPI
Igor Fattakhov
- Pharmacist
- Forest Hills, NY
National Provider Identifier
1346539145
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 054429
- Practice address
- 6838 Yellowstone Blvd
Apt A46
Forest Hills, NY 11375-3417 - Phone
- (646) 236-6325
- NPI assigned
- Apr 1, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 054429 | NY | Primary |
Addresses
Primary practice location
6838 Yellowstone Blvd
Apt A46
Forest Hills, NY 11375-3417
Mailing address
6838 Yellowstone Blvd
Apt A46
Forest Hills, NY 11375-3417
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 054429 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aiie Corp | Current | Accepting new patients |
Organizations & group practices 1
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.
-
- Community/Retail Pharmacy
- Kew Gardens, NY
- NPI 1730695164
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1301616000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1301616000000",
"number": "1346539145",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6838 YELLOWSTONE BLVD",
"address_2": "APT A46",
"city": "FOREST HILLS",
"state": "NY",
"postal_code": "113753417"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6838 YELLOWSTONE BLVD",
"address_2": "APT A46",
"city": "FOREST HILLS",
"state": "NY",
"postal_code": "113753417",
"telephone_number": "646-236-6325"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FATTAKHOV",
"first_name": "IGOR",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-04-01",
"last_updated": "2011-04-01",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "054429",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Forest Hills, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.