Healthcare Provider Details

I. General information

NPI: 1184739799
Provider Name (Legal Business Name): TATIANA KHROM, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2797 OCEAN PKWY STE 3
BROOKLYN NY
11235-7868
US

IV. Provider business mailing address

2797 OCEAN PARKWAY 3RD FLOOR
BROOKLYN NY
11235-7868
US

V. Phone/Fax

Practice location:
  • Phone: 718-615-4000
  • Fax: 718-615-4004
Mailing address:
  • Phone: 718-615-4000
  • Fax: 718-615-4004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number227196
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number227196
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number227196
License Number StateNY

VIII. Authorized Official

Name: DR. TATIANA KHROM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 646-479-8039