Provider Demographics
NPI:1407967482
Name:NIKIFOROV, KONSTANTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:KONSTANTIN
Middle Name:
Last Name:NIKIFOROV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 OCEANA DR E
Mailing Address - Street 2:APT. 4B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6686
Mailing Address - Country:US
Mailing Address - Phone:718-577-7783
Mailing Address - Fax:
Practice Address - Street 1:20 E 46TH ST RM 1200
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-9246
Practice Address - Country:US
Practice Address - Phone:646-850-2290
Practice Address - Fax:646-850-2295
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2020-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2234942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02258717Medicaid
NY02258717Medicaid
NY140B01Medicare ID - Type Unspecified