Provider Demographics
NPI:1598190050
Name:KHODIK, KALMAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KALMAN
Middle Name:
Last Name:KHODIK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1177 AVENUE OF THE AMERICAS FL 5
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-2714
Mailing Address - Country:US
Mailing Address - Phone:888-284-8272
Mailing Address - Fax:888-284-8272
Practice Address - Street 1:1177 AVENUE OF THE AMERICAS FL 5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-2714
Practice Address - Country:US
Practice Address - Phone:888-284-8272
Practice Address - Fax:888-284-8272
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-03
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021116103TC0700X
NJ35SI00554800103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300123051Medicare PIN