Provider Demographics
NPI:1104132778
Name:PROKHOROV'S PEDIATRICS AND CHILD NEUROLOGY PC
Entity type:Organization
Organization Name:PROKHOROV'S PEDIATRICS AND CHILD NEUROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PROKHOROVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-938-8762
Mailing Address - Street 1:9817 QUEENS BLVD
Mailing Address - Street 2:LL2
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3336
Mailing Address - Country:US
Mailing Address - Phone:718-275-5600
Mailing Address - Fax:718-275-5608
Practice Address - Street 1:9817 QUEENS BLVD
Practice Address - Street 2:LL2
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3336
Practice Address - Country:US
Practice Address - Phone:718-275-5600
Practice Address - Fax:718-275-5608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-20
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Multi-Specialty