Healthcare Provider Details

I. General information

NPI: 1649598731
Provider Name (Legal Business Name): VYACHESLAV MIKHEYEV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2010
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1167 NOSTRAND AVE
BROOKLYN NY
11225-5417
US

IV. Provider business mailing address

60 MADISON AVE 5TH FLOOR
NEW YORK NY
10010-1600
US

V. Phone/Fax

Practice location:
  • Phone: 718-778-0198
  • Fax: 718-221-8169
Mailing address:
  • Phone: 212-545-2439
  • Fax: 646-312-0481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number268916
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: