Provider Demographics
NPI:1760573851
Name:KHRAKOVSKY, VERA (DPM)
Entity Type:Individual
Prefix:
First Name:VERA
Middle Name:
Last Name:KHRAKOVSKY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2565 MORRIS AVENUE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5613
Mailing Address - Country:US
Mailing Address - Phone:908-687-3343
Mailing Address - Fax:908-687-3343
Practice Address - Street 1:2565 MORRIS AVENUE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5613
Practice Address - Country:US
Practice Address - Phone:908-687-3343
Practice Address - Fax:908-687-3343
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD1942213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1928007Medicaid
NJ161791Medicare ID - Type Unspecified
NJ1928007Medicaid
NJ5322360001Medicare NSC