Individual provider Active NPI

Alexander Mikhailov, D.D.S

  • General Practice Dentistry
  • Elmhurst, NY
National Provider Identifier
1891776092
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
041796-1 Issued in NY
Practice address
9015 Queens Blvd
Elmhurst, NY 11373-4900
Phone
(718) 760-1616
Fax
(718) 760-9647
NPI assigned
Nov 7, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 041796-1 NY Primary

Addresses

Primary practice location

9015 Queens Blvd
Elmhurst, NY 11373-4900

Mailing address

9015 Queens Blvd
Elmhurst, NY 11373-4900
Phone (718) 760-1616

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151012001608 NY Order and Referring Only - DentistPractitioner - Dentist 3173832201

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
041796-1NYMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1131321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1891776092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9015 QUEENS BLVD",
            "city": "ELMHURST",
            "state": "NY",
            "postal_code": "113734900",
            "telephone_number": "718-760-1616",
            "fax_number": "718-760-9647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9015 QUEENS BLVD",
            "city": "ELMHURST",
            "state": "NY",
            "postal_code": "113734900",
            "telephone_number": "718-760-1616",
            "fax_number": "718-760-9647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIKHAILOV",
        "first_name": "ALEXANDER",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "041796-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elmhurst, NY

Sources for this page

Verify at the official NPI Registry.