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General NPI Number Information
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NPI Number | 1437871977
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Entity Type | Organization
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Legal Business Name | KHAITOV MEDICAL PLLC
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Dates
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Enumeration Date | 09/12/2022
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Last Update Date | 09/12/2022
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Provider Practice Location Address
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Address Line | 60 W 68TH ST APT 1B
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City | NEW YORK
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State | NY
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Zip | 10023-6048
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Country | US
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Telephone | 646-724-8066
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Fax |
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Provider Business Mailing Address
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Address Line | 7925 150TH ST APT F19
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City | FLUSHING
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State | NY
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Zip | 11367-3817
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Country | US
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Telephone | 646-724-8066
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Fax |
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Authorized Official
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Title or Position | CEO / PHYSICIAN
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Name | MIKHAIL KHAITOV
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Credential | DO
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Telephone | 646-724-8066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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