Provider Demographics
NPI:1285843425
Name:KATAYEV, MICHAEL I (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:I
Last Name:KATAYEV
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E 40TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-2188
Mailing Address - Country:US
Mailing Address - Phone:212-905-0081
Mailing Address - Fax:212-905-0084
Practice Address - Street 1:300 E 40TH ST STE B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-2188
Practice Address - Country:US
Practice Address - Phone:212-905-0081
Practice Address - Fax:212-905-0084
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052850122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY205319722OtherTAX ID
NY02771566Medicaid