Healthcare Provider Details

I. General information

NPI: 1104532423
Provider Name (Legal Business Name): NICOLE BABAYEV
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2023
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14928 14TH AVE
WHITESTONE NY
11357-1730
US

IV. Provider business mailing address

41 STIRRUP LN
ROSLYN HEIGHTS NY
11577-2515
US

V. Phone/Fax

Practice location:
  • Phone: 718-746-9862
  • Fax:
Mailing address:
  • Phone: 917-745-7919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number070060
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: