Healthcare Provider Details

I. General information

NPI: 1215496419
Provider Name (Legal Business Name): DANIIL KHAITOV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3629 BELL BLVD
BAYSIDE NY
11361-2056
US

IV. Provider business mailing address

900 MERCHANTS CONCOURSE STE 216
WESTBURY NY
11590-5114
US

V. Phone/Fax

Practice location:
  • Phone: 718-224-5800
  • Fax: 718-423-6655
Mailing address:
  • Phone: 516-226-8373
  • Fax: 516-226-8373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number317997-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: