Provider Demographics
NPI:1346813037
Name:KHAIMOVA, FRIDA (NP)
Entity Type:Individual
Prefix:
First Name:FRIDA
Middle Name:
Last Name:KHAIMOVA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 E SHORE RD
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-2923
Mailing Address - Country:US
Mailing Address - Phone:516-487-5577
Mailing Address - Fax:516-487-2947
Practice Address - Street 1:315 E SHORE RD
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-2923
Practice Address - Country:US
Practice Address - Phone:516-487-5577
Practice Address - Fax:516-487-2947
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF309701-01363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health