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General NPI Number Information
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NPI Number | 1851575724
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Entity Type | Individual
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Provider Name | DMITRIY KHAZRON D.O
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Gender | Male
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Dates
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Enumeration Date | 12/27/2007
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Last Update Date | 07/02/2015
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Provider Practice Location Address
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Address Line | 475 SEAVIEW AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10305-3436
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Country | US
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Telephone | 718-226-1008
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Fax |
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Provider Business Mailing Address
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Address Line | 915 EAST 7 STREET APT. 5G
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City | BROOKLYN
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State | NY
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Zip | 11230
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Country | US
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Telephone | 718-338-3247
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051901
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 279834
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License Number State | NY
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