Provider Demographics
NPI:1376587246
Name:PAIKIN, MIKHAIL (MD,DO)
Entity Type:Individual
Prefix:DR
First Name:MIKHAIL
Middle Name:
Last Name:PAIKIN
Suffix:
Gender:M
Credentials:MD,DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 SAND LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4512
Mailing Address - Country:US
Mailing Address - Phone:718-541-2939
Mailing Address - Fax:
Practice Address - Street 1:288 SAND LN
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-4512
Practice Address - Country:US
Practice Address - Phone:718-541-2939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223328170100000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02238017Medicaid
NYH60736Medicare UPIN
NY45V541Medicare ID - Type Unspecified