Provider Demographics
NPI:1336132000
Name:HAYMOV, GADDY ABRAHAM (MD)
Entity Type:Individual
Prefix:DR
First Name:GADDY
Middle Name:ABRAHAM
Last Name:HAYMOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 MCLEAN AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-3847
Mailing Address - Country:US
Mailing Address - Phone:914-776-6483
Mailing Address - Fax:914-776-0855
Practice Address - Street 1:803 MCLEAN AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-3847
Practice Address - Country:US
Practice Address - Phone:914-776-6483
Practice Address - Fax:914-776-0855
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208605207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01954723Medicaid
NY49C931Medicare UPIN
G95648Medicare UPIN