Provider Demographics
NPI:1669483426
Name:KHAIMOV, GAVRIIL (DPM)
Entity Type:Individual
Prefix:DR
First Name:GAVRIIL
Middle Name:
Last Name:KHAIMOV
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6909 138TH ST
Mailing Address - Street 2:2C
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1603
Mailing Address - Country:US
Mailing Address - Phone:718-263-4013
Mailing Address - Fax:
Practice Address - Street 1:185 BRIDGE PLZ N
Practice Address - Street 2:SUITE #4
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-5907
Practice Address - Country:US
Practice Address - Phone:201-363-9844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2011-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006045213ES0103X
NJ25MD00295000213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery