Healthcare Provider Details

I. General information

NPI: 1710226162
Provider Name (Legal Business Name): NINA BABAYEV DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2013
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 55TH ST
BROOKLYN NY
11220-2508
US

IV. Provider business mailing address

8410 MAIN STREET APT 449
JAMAICA NY
11435
US

V. Phone/Fax

Practice location:
  • Phone: 718-630-6875
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5184743817
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: