Provider Demographics
NPI:1558545673
Name:GERIATRIC ASSOCIATE P.C
Entity Type:Organization
Organization Name:GERIATRIC ASSOCIATE P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KHASKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-645-8303
Mailing Address - Street 1:1923 HOMECREST AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2709
Mailing Address - Country:US
Mailing Address - Phone:718-645-8303
Mailing Address - Fax:718-645-8507
Practice Address - Street 1:1923 HOMECREST AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2709
Practice Address - Country:US
Practice Address - Phone:718-645-8303
Practice Address - Fax:718-645-8507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01662326Medicaid
NY01662326Medicaid