Provider Demographics
NPI:1467864496
Name:EVA KHAVKIN MEDICAL PC
Entity Type:Organization
Organization Name:EVA KHAVKIN MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EVA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAVKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-835-9130
Mailing Address - Street 1:47 ROBBINS AVE
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-4012
Mailing Address - Country:US
Mailing Address - Phone:631-835-9130
Mailing Address - Fax:631-539-2290
Practice Address - Street 1:47 ROBBINS AVE
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-4012
Practice Address - Country:US
Practice Address - Phone:631-835-9130
Practice Address - Fax:631-539-2290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-26
Last Update Date:2014-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190588261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY66I232Medicare UPIN