Provider Demographics
NPI:1659676930
Name:YURIY KHANIN MD, P.C.
Entity Type:Organization
Organization Name:YURIY KHANIN MD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTENDING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:YURIY
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-523-5776
Mailing Address - Street 1:10753 GUY R BREWER BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11433-2351
Mailing Address - Country:US
Mailing Address - Phone:718-523-5776
Mailing Address - Fax:718-526-1132
Practice Address - Street 1:10753 GUY R BREWER BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11433-2351
Practice Address - Country:US
Practice Address - Phone:718-523-5776
Practice Address - Fax:718-526-1132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230941208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02554736Medicaid