MEDICARE: DR. MIKHAIL BABAYAN DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0700X	Prosthodontics	063430-01	NY

General Provider Information

NPI Number	:	1336778638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIKHAIL BABAYAN DMD

Provider Business Mailing Address
First Line	:	6245 AMBOY RD APT 1
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-3138
Country	:	US
Telephone Number	:	917-742-9952
Fax Number	:

Provider Business Practice Location Address
First Line	:	3987 RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-5112
Country	:	US
Telephone Number	:	718-776-4159
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2020
Last Update Date	:	03/29/2024

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