Healthcare Provider Details

I. General information

NPI: 1013959618
Provider Name (Legal Business Name): VASSILY MIHAILOFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 02/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 W COLE RD
BIDDEFORD ME
04005-9428
US

IV. Provider business mailing address

1050 WALL ST W STE 360
LYNDHURST NJ
07071-3604
US

V. Phone/Fax

Practice location:
  • Phone: 207-284-6114
  • Fax: 207-282-6118
Mailing address:
  • Phone: 201-821-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number012135
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: