Healthcare Provider Details

I. General information

NPI: 1376587246
Provider Name (Legal Business Name): MIKHAIL PAIKIN M.D.,D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 05/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 SAND LN
STATEN ISLAND NY
10305-4512
US

IV. Provider business mailing address

288 SAND LN
STATEN ISLAND NY
10305-4512
US

V. Phone/Fax

Practice location:
  • Phone: 718-541-2939
  • Fax:
Mailing address:
  • Phone: 718-541-2939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number223328
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number223328
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: