Provider Demographics
NPI:1427149673
Name:KHAIMOV, BORIS (RPA-C)
Entity type:Individual
Prefix:MR
First Name:BORIS
Middle Name:
Last Name:KHAIMOV
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 MAIN ST
Mailing Address - Street 2:SUITE#416
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-1722
Mailing Address - Country:US
Mailing Address - Phone:718-431-5251
Mailing Address - Fax:718-830-1149
Practice Address - Street 1:8401 MAIN ST
Practice Address - Street 2:SUITE#416
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-1722
Practice Address - Country:US
Practice Address - Phone:718-431-5251
Practice Address - Fax:718-830-1149
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007580363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical