Provider Demographics
NPI:1417995358
Name:KHASIDY, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:KHASIDY
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 1:2797 OCEAN PKWY
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-7861
Mailing Address - Country:US
Mailing Address - Phone:718-332-7111
Mailing Address - Fax:718-332-7110
Practice Address - Street 1:2797 OCEAN PKWY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7861
Practice Address - Country:US
Practice Address - Phone:718-332-7111
Practice Address - Fax:718-332-7110
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1630021207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00900367Medicaid
NY46D601Medicare PIN