Provider Demographics
NPI:1053503110
Name:KHOSHAYEV, ARON S (DPT)
Entity Type:Individual
Prefix:
First Name:ARON
Middle Name:S
Last Name:KHOSHAYEV
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7581 177TH ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1522
Mailing Address - Country:US
Mailing Address - Phone:718-475-2161
Mailing Address - Fax:718-709-7987
Practice Address - Street 1:7581 177TH ST
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366
Practice Address - Country:US
Practice Address - Phone:718-475-2161
Practice Address - Fax:718-709-7987
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029566225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist