MEDICARE: JONATHAN BABAYEV

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	183500000X	Pharmacist	I068526	NY

General Provider Information

NPI Number	:	1558027672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN BABAYEV

Provider Business Mailing Address
First Line	:	965 BROADHOLLOW RD
Second Line	:
City	:	FARMINGDALE
State	:	NY
Zip	:	11735-3906
Country	:	US
Telephone Number	:	631-752-8980
Fax Number	:

Provider Business Practice Location Address
First Line	:	8023 208TH ST
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11427-1006
Country	:	US
Telephone Number	:	347-944-8532
Fax Number	:

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

Provider Enumeration Date	:	11/12/2021
Last Update Date	:	11/12/2021

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Directions to “ JONATHAN BABAYEV ” Practice Location

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