Provider Demographics
NPI:1578530788
Name:RIKHER, KIRILL V (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:KIRILL
Middle Name:V
Last Name:RIKHER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3060 OCEAN AVE
Mailing Address - Street 2:SUITE L-A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3364
Mailing Address - Country:US
Mailing Address - Phone:718-769-0400
Mailing Address - Fax:718-769-0183
Practice Address - Street 1:3060 OCEAN AVE
Practice Address - Street 2:SUITE L-A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3364
Practice Address - Country:US
Practice Address - Phone:718-769-0400
Practice Address - Fax:718-769-0183
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195662207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01755839Medicaid
NYW35281Medicare ID - Type UnspecifiedGROUP MEDICARE #
NY38X132Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #
NY01755839Medicaid