Healthcare Provider Details

I. General information

NPI: 1871430298
Provider Name (Legal Business Name): RACHEL KHAIMOVA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 N TYSON AVE STE 100
FLORAL PARK NY
11001-1469
US

IV. Provider business mailing address

14427 78TH AVE
FLUSHING NY
11367-3430
US

V. Phone/Fax

Practice location:
  • Phone: 718-276-7935
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF358895
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: