Healthcare Provider Details

I. General information

NPI: 1215836614
Provider Name (Legal Business Name): ARIEL DAVYDOV
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2026
Last Update Date: 11/02/2026
Certification Date: 11/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9905 67TH AVE
REGO PARK NY
11374-4513
US

IV. Provider business mailing address

9905 67TH AVE
REGO PARK NY
11374-4513
US

V. Phone/Fax

Practice location:
  • Phone: 917-974-2772
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number074756
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: