MEDICARE: EVA KHAVKIN MEDICAL 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
1	261QH0100X	Health Service Clinic/Center	190588	NY

General Provider Information

NPI Number	:	1467864496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVA KHAVKIN MEDICAL PC

Provider Business Mailing Address
First Line	:	47 ROBBINS AVE
Second Line	:
City	:	BABYLON
State	:	NY
Zip	:	11702-4012
Country	:	US
Telephone Number	:	631-835-9130
Fax Number	:	631-539-2290

Provider Business Practice Location Address
First Line	:	47 ROBBINS AVE
Second Line	:
City	:	BABYLON
State	:	NY
Zip	:	11702-4012
Country	:	US
Telephone Number	:	631-835-9130
Fax Number	:	631-539-2290

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EVA KHAVKIN
Credential	:	M.D.
Telephone Number	:	631-835-9130

Provider Enumeration Date	:	05/26/2014
Last Update Date	:	05/26/2014

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