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NPI Code Detail

MEDICARE: IRINA KHAIMOVICH

MEDICARE: IRINA KHAIMOVICH
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
1171M00000XCase Manager/Care Coordinator
2174400000XSpecialist1823038241NY

General Provider Information

NPI Number : 1821589011
Entity Type Code : Individual
Provider Name (Legal Business Name) : IRINA KHAIMOVICH
Provider Business Mailing Address
First Line : 2819 W 12TH ST APT 3N
Second Line :
City : BROOKLYN
State : NY
Zip : 11224-3118
Country : US
Telephone Number : 917-420-3883
Fax Number :
Provider Business Practice Location Address
First Line : 2571 E 17TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11235-3585
Country : US
Telephone Number : 929-371-2131
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2018
Last Update Date : 09/06/2024

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