Provider Demographics
NPI:1275534935
Name:KHAVASH, ALEXANDER (DC)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:KHAVASH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 PICCADILLY DWNS
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-3145
Mailing Address - Country:US
Mailing Address - Phone:718-373-6656
Mailing Address - Fax:718-373-6656
Practice Address - Street 1:438 9TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4177
Practice Address - Country:US
Practice Address - Phone:718-788-7007
Practice Address - Fax:718-788-7707
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010592111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP3304901OtherOXFORD
NY3422298OtherAETNA
NY010592-NYOther1199
NY1049460OtherASHN
NY02463376Medicaid
NY5808094OtherGHI
NY660778OtherACN
NYX8U332OtherEMPIRE BCBS
NYX8U332OtherEMPIRE BCBS
NYX6K381Medicare ID - Type UnspecifiedNY MEDICARE