Provider Demographics
NPI:1336670173
Name:KHANIMOV, MOISEY (MD)
Entity type:Individual
Prefix:DR
First Name:MOISEY
Middle Name:
Last Name:KHANIMOV
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 1:6838 YELLOWSTONE BLVD APT A40
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3420
Mailing Address - Country:US
Mailing Address - Phone:646-520-5230
Mailing Address - Fax:
Practice Address - Street 1:95-25 QUEENS BLVD
Practice Address - Street 2:5TH FLR
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1995
Practice Address - Country:US
Practice Address - Phone:718-460-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY303661-01207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program