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General NPI Number Information
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NPI Number | 1013555861
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Entity Type | Organization
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Legal Business Name | CLEAR MIND PSYCHIARTY OF MANHATTAN
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Dates
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Enumeration Date | 12/11/2019
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Last Update Date | 06/11/2020
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Provider Practice Location Address
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Address Line | 276 5TH AVE RM 1101
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City | NEW YORK
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State | NY
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Zip | 10001-4544
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Country | US
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Telephone | 917-981-9086
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Fax | 917-477-2278
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Provider Business Mailing Address
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Address Line | 6238 DIETERLE CRES
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City | REGO PARK
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State | NY
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Zip | 11374-4836
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Country | US
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Telephone | 917-981-9086
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Fax | 917-477-2278
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Authorized Official
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Title or Position | PSYCHIATRY
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Name | DR. BORIS A KHAIMOV
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Credential | DO
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Telephone | 917-981-9086
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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