Provider Demographics
NPI:1013959618
Name:MIHAILOFF, VASSILY (MD)
Entity Type:Individual
Prefix:DR
First Name:VASSILY
Middle Name:
Last Name:MIHAILOFF
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 1:1050 WALL ST W STE 360
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-3604
Mailing Address - Country:US
Mailing Address - Phone:201-821-7900
Mailing Address - Fax:
Practice Address - Street 1:28 W COLE RD
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9428
Practice Address - Country:US
Practice Address - Phone:207-284-6114
Practice Address - Fax:207-282-6118
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME012135207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0104586Y0ME01OtherBLUE CROSS BLUE SHIELD
ME002110OtherBLUE CROSS BLUE SHIELD
ME1042105OtherAETNA
ME125300000Medicaid
ME002110OtherBLUE CROSS BLUE SHIELD
ME125300000Medicaid