Fattakhov, Vyacheslav

Fattakhov, Vyacheslav is an individual health care provider with primary practice located at 108 Burnham Ave , Roslyn Heights NY 11577-1935. He recently has only one registered license in Allopathic & Osteopathic Physicians / Anesthesiology, which is considered as his primary health care specialty. Fattakhov, Vyacheslav can be contacted via phone (718) 795-7586.

Contact Information

Primary practice address
108 Burnham Ave Roslyn Heights NY 11577-1935
Phone: (718) 795-7586
Fax: (347) 826-4155
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Anesthesiology 207L00000X 231594-1 New York

Profile Details

NPI number 1952395303
LBN Legal business name Fattakhov, Vyacheslav
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 31st, 2005
Last updated May 1st, 2013 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1952395303 NPPES
New York MEDICAID 02591748
New York Other WHNA21

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