Provider Demographics
NPI:1215780374
Name:BACHAYEV, MIKHAIL
Entity type:Individual
Prefix:
First Name:MIKHAIL
Middle Name:
Last Name:BACHAYEV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9947 63RD RD # 2R
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1939
Mailing Address - Country:US
Mailing Address - Phone:720-261-6474
Mailing Address - Fax:
Practice Address - Street 1:9947 63RD RD APT 2R
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1939
Practice Address - Country:US
Practice Address - Phone:720-261-6474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-09
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)