Provider Demographics
NPI:1669535217
Name:BENJAMIN V KATAYEV DDS PC
Entity type:Organization
Organization Name:BENJAMIN V KATAYEV DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:V
Authorized Official - Last Name:KATAYEV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-379-1700
Mailing Address - Street 1:1401 DEKRUIP PLACE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-2201
Mailing Address - Country:US
Mailing Address - Phone:718-379-1700
Mailing Address - Fax:718-379-8921
Practice Address - Street 1:1401 DEKRUIF PLACE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-2201
Practice Address - Country:US
Practice Address - Phone:718-379-1700
Practice Address - Fax:718-379-8921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04771111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01896900Medicaid