MEDICARE: DR. MICHAEL I. KATAYEV DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	052850	NY
2	1223G0001X	General Practice Dentistry	052850	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	205319722	OTHER	NY	TAX ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285843425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL I. KATAYEV DDS

Provider Business Mailing Address
First Line	:	300 E 40TH ST STE B
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-2188
Country	:	US
Telephone Number	:	212-905-0081
Fax Number	:	212-905-0084

Provider Business Practice Location Address
First Line	:	300 E 40TH ST STE B
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-2188
Country	:	US
Telephone Number	:	212-905-0081
Fax Number	:	212-905-0084

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	10/05/2020

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