1275534935 NPI number — DR. ALEXANDER KHAVASH DC

Table of content: DR. ALEXANDER KHAVASH DC (NPI 1275534935)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275534935 NPI number — DR. ALEXANDER KHAVASH DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KHAVASH
Provider First Name:
ALEXANDER
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275534935
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
223 PICCADILLY DWNS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNBROOK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11563-3145
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-373-6656
Provider Business Mailing Address Fax Number:
718-373-6656

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
438 9TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11215-4177
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-788-7007
Provider Business Practice Location Address Fax Number:
718-788-7707
Provider Enumeration Date:
08/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  010592 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P3304901 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3422298 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 010592-NY . This is a "1199" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1049460 . This is a "ASHN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02463376 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5808094 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 660778 . This is a "ACN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: X8U332 . This is a "EMPIRE BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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