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NPI Code Detail

MEDICARE: ALBERT KHODOSH DDS PC

MEDICARE: ALBERT KHODOSH DDS PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist044992NY

General Provider Information

NPI Number : 1427336544
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALBERT KHODOSH DDS PC
Provider Business Mailing Address
First Line : 2085 E 27TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11229-5001
Country : US
Telephone Number : 718-375-4269
Fax Number : 718-769-6622
Provider Business Practice Location Address
First Line : 2085 E 27TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11229-5001
Country : US
Telephone Number : 718-375-4269
Fax Number : 718-769-6622
Authorized Official
Title or Position : DENTIST
Name : MR. ALBERT KHODOSH
Credential : D.D.S.
Telephone Number : 718-375-4269
Provider Enumeration Date : 07/22/2011
Last Update Date : 07/22/2011

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