Basic Information
| Provider Information | |||||||||
| NPI: | 1871917799 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAYZIYEV | ||||||||
| FirstName: | DANIIL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7736 167TH ST | ||||||||
| Address2: | |||||||||
| City: | FRESH MEADOWS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113661304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6464202825 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4422 3RD AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104572545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189609000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2014 | ||||||||
| LastUpdateDate: | 06/23/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | UNKNOWN | MD | N | Dental Providers | Dentist | 1223G0001X | 11357 | CT | Y | Dental Providers | Dentist | General Practice |
No ID Information.