Provider Demographics
NPI:1013555861
Name:CLEAR MIND PSYCHIARTY OF MANHATTAN
Entity Type:Organization
Organization Name:CLEAR MIND PSYCHIARTY OF MANHATTAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRY
Authorized Official - Prefix:DR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHAIMOV
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:917-981-9086
Mailing Address - Street 1:6238 DIETERLE CRES
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4836
Mailing Address - Country:US
Mailing Address - Phone:917-981-9086
Mailing Address - Fax:917-477-2278
Practice Address - Street 1:276 5TH AVE RM 1101
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-4544
Practice Address - Country:US
Practice Address - Phone:917-981-9086
Practice Address - Fax:917-477-2278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty