Provider Demographics
NPI:1215299466
Name:KHAIMOVA, BELLA
Entity type:Individual
Prefix:
First Name:BELLA
Middle Name:
Last Name:KHAIMOVA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7809 160TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1942
Mailing Address - Country:US
Mailing Address - Phone:718-850-0400
Mailing Address - Fax:718-850-4441
Practice Address - Street 1:7809 160TH ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11366-1942
Practice Address - Country:US
Practice Address - Phone:718-850-0400
Practice Address - Fax:718-850-4441
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator