Provider Demographics
NPI:1437871977
Name:KHAITOV MEDICAL PLLC
Entity Type:Organization
Organization Name:KHAITOV MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MIKHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAITOV
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:646-724-8066
Mailing Address - Street 1:7925 150TH ST APT F19
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3817
Mailing Address - Country:US
Mailing Address - Phone:646-724-8066
Mailing Address - Fax:
Practice Address - Street 1:60 W 68TH ST APT 1B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-6048
Practice Address - Country:US
Practice Address - Phone:646-724-8066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty