Individual provider Active NPI

Larisa Mikhaylov, MD

  • Pediatrics Physician
  • Rockville Centre, NY
National Provider Identifier
1477737666
Registry record updated Apr 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
167427 Issued in NY
Practice address
1000 N. Village Avenue
Rockville Centre, NY 11571
Phone
(516) 705-1353
Fax
(516) 705-3575
NPI assigned
Dec 24, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 167427 NY Primary

Addresses

Primary practice location

1000 N. Village Avenue
Rockville Centre, NY 11571

Mailing address

P.O Box 798
Rockville Centre, NY 11571
Phone (516) 705-1353

Other identifiers 1

IdentifierTypeStateIssuer
167427OtherNYLICENSE

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
I20260429002738 NY Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 9335616119

National Provider Directory

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

NPI Registry JSON

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

{
    "created_epoch": "1198454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207094400000",
    "number": "1477737666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O BOX 798",
            "city": "ROCKVILLE CENTRE",
            "state": "NY",
            "postal_code": "11571",
            "telephone_number": "516-705-1353",
            "fax_number": "516-705-3575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 N. VILLAGE AVENUE",
            "city": "ROCKVILLE CENTRE",
            "state": "NY",
            "postal_code": "11571",
            "telephone_number": "516-705-1353",
            "fax_number": "516-705-3575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIKHAYLOV",
        "first_name": "LARISA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-12-24",
        "last_updated": "2008-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "167427",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "167427",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockville Centre, NY

Sources for this page

Verify at the official NPI Registry.