Healthcare Provider Details

I. General information

NPI: 1750062501
Provider Name (Legal Business Name): JOHN AKHNOUKH MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1991 MARCUS AVE
NORTH NEW HYDE PARK NY
11042-2057
US

IV. Provider business mailing address

12 CENTER DR
ROSLYN NY
11576-1402
US

V. Phone/Fax

Practice location:
  • Phone: 516-229-1443
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN AKHNOUKH
Title or Position: OWNER AND CEO
Credential: MD
Phone: 917-930-2668