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General NPI Number Information
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NPI Number | 1225473267
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Entity Type | Individual
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Provider Name | RENATA KHELEMSKY MD
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Gender | Female
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Dates
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Enumeration Date | 05/03/2013
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Last Update Date | 10/11/2023
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Provider Practice Location Address
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Address Line | 58 PROSPECT ST
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City | BROOKLYN
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State | NY
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Zip | 11201-3282
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Country | US
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Telephone | 646-558-3757
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Fax |
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Provider Business Mailing Address
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Address Line | 58 PROSPECT ST
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City | BROOKLYN
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State | NY
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Zip | 11201-3282
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Country | US
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Telephone | 646-558-3757
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 292736
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number | 292736
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License Number State | NY
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