Provider Demographics
NPI:1548401854
Name:ATAKHANOV, CHAVKAT E (MD, PHD, D SC)
Entity Type:Individual
Prefix:
First Name:CHAVKAT
Middle Name:E
Last Name:ATAKHANOV
Suffix:
Gender:M
Credentials:MD, PHD, D SC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:681 CLARKSON AVE
Mailing Address - Street 2:KINGSBORO PSYCHIATRIC CENTER, BLDG 1, WARD #22
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2125
Mailing Address - Country:US
Mailing Address - Phone:718-221-7752
Mailing Address - Fax:
Practice Address - Street 1:681 CLARKSON AVE
Practice Address - Street 2:KINGSBORO PSYCHIATRIC CENTER, BLDG 1, WARD #22
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2125
Practice Address - Country:US
Practice Address - Phone:718-221-7752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP629342084P0015X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine