Provider Demographics
NPI:1730141979
Name:KHILKIN, ANATOLI (MD)
Entity Type:Individual
Prefix:
First Name:ANATOLI
Middle Name:
Last Name:KHILKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 HENRY HUDSON PKWY
Mailing Address - Street 2:APT 4N
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-3262
Mailing Address - Country:US
Mailing Address - Phone:718-543-6916
Mailing Address - Fax:718-543-6916
Practice Address - Street 1:201-23 BRIGHTON 1ST RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7650
Practice Address - Country:US
Practice Address - Phone:718-648-3011
Practice Address - Fax:718-648-1786
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168153208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01008662Medicaid
NY01008662Medicaid
A64933Medicare UPIN