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NPI Code Detail

MEDICARE: RENA KHANUKAYEVA

MEDICARE: RENA KHANUKAYEVA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician212257NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255358164
Entity Type Code : Individual
Provider Name (Legal Business Name) : RENA KHANUKAYEVA
Provider Business Mailing Address
First Line : 34 DUMONT AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10305-1450
Country : US
Telephone Number : 718-980-3232
Fax Number : 718-980-3233
Provider Business Practice Location Address
First Line : 34 DUMONT AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10305-1450
Country : US
Telephone Number : 718-980-3232
Fax Number : 718-980-3233
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2006
Last Update Date : 09/24/2024

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Directions to “ RENA KHANUKAYEVA ” Practice Location

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