MEDICARE: FAINA KHMELNITSKY OD

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	152W00000X	Optometrist	TUV006850	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891983920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAINA KHMELNITSKY OD

Provider Business Mailing Address
First Line	:	425 MADISON AVE
Second Line	:	SUITE 1501
City	:	NEW YORK
State	:	NY
Zip	:	10017-1110
Country	:	US
Telephone Number	:	212-230-1780
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 MADISON AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-3422
Country	:	US
Telephone Number	:	212-230-1780
Fax Number	:	212-683-1947

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2007
Last Update Date	:	06/06/2016

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