Provider Demographics
NPI:1265645154
Name:ENIKEEV, ISKANDER DERD (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:ISKANDER
Middle Name:DERD
Last Name:ENIKEEV
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CORBIN PL
Mailing Address - Street 2:UNIT C1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4801
Mailing Address - Country:US
Mailing Address - Phone:718-331-3800
Mailing Address - Fax:718-331-3387
Practice Address - Street 1:7 CORBIN PL
Practice Address - Street 2:UNIT C1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-4801
Practice Address - Country:US
Practice Address - Phone:718-331-3800
Practice Address - Fax:718-331-3387
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2039482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01737237Medicaid
NY03844GMedicare PIN
NY01737237Medicaid
NYG41439Medicare UPIN