Healthcare Provider Details

I. General information

NPI: 1134323132
Provider Name (Legal Business Name): ALEKSANDR KHAIMOV D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 01/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9614 METROPOLITAN AVE 2ND FLOOR, SUITE A
FOREST HILLS NY
11375-6625
US

IV. Provider business mailing address

9614 METROPOLITAN AVE 2ND FLOOR, SUITE A
FOREST HILLS NY
11375-6625
US

V. Phone/Fax

Practice location:
  • Phone: 718-785-4645
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number248464
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: