Provider Demographics
NPI:1558998104
Name:KHAMISHON, SOLOMON JOSEPH
Entity Type:Individual
Prefix:DR
First Name:SOLOMON
Middle Name:JOSEPH
Last Name:KHAMISHON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:SHLOMO
Other - Middle Name:JOSEPH
Other - Last Name:KHAMISHON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:101 NICOLLS RD
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8434
Mailing Address - Country:US
Mailing Address - Phone:631-638-2698
Mailing Address - Fax:
Practice Address - Street 1:101 NICOLLS RD
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8434
Practice Address - Country:US
Practice Address - Phone:631-638-2698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program