Provider Demographics
NPI:1790963460
Name:ALEXANDER KHAVASH DC PC
Entity Type:Organization
Organization Name:ALEXANDER KHAVASH DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAVASH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-788-7007
Mailing Address - Street 1:223 PICCADILLY DWNS
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-3145
Mailing Address - Country:US
Mailing Address - Phone:718-788-7007
Mailing Address - Fax:718-788-7707
Practice Address - Street 1:438 9TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4177
Practice Address - Country:US
Practice Address - Phone:718-788-7007
Practice Address - Fax:718-788-7707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX8U332OtherEMPIRE BCBS
NY010592-NYOther1199
NY02463376Medicaid
NY660778OtherACN
NYC10592-6WOtherWORKER'S COMPENSATION
NY3422298OtherAETNA
NY1049460OtherASHN
NY5808094OtherGHI
NYP3304901OtherOXFORD
NY5808094OtherGHI
NYC10592-6WOtherWORKER'S COMPENSATION