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General NPI Number Information
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NPI Number | 1720297872
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Entity Type | Individual
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Provider Name | BORIS KHAIMOV D.O,
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Gender | Male
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 02/15/2022
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Provider Practice Location Address
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Address Line | 11 GRACE AVE STE 204
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City | GREAT NECK
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State | NY
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Zip | 11021-2417
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Country | US
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Telephone | 917-551-6652
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Fax |
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Provider Business Mailing Address
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Address Line | 6725 DARTMOUTH ST 3N
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City | FOREST HILLS
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State | NY
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Zip | 11375-4058
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Country | US
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Telephone | 171-826-3382
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 249224
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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