Healthcare Provider Details

I. General information

NPI: 1942885728
Provider Name (Legal Business Name): CATHIE BABADZHANOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2021
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4422 3RD AVE
BRONX NY
10457-2545
US

IV. Provider business mailing address

11624 GROSVENOR LN APT 10D
RICHMOND HILL NY
11418-3451
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-9000
  • Fax:
Mailing address:
  • Phone: 347-233-1356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number062533-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: