Provider Demographics
NPI:1962431148
Name:KHELEMSKY, IGOR (MD)
Entity type:Individual
Prefix:MR
First Name:IGOR
Middle Name:
Last Name:KHELEMSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:IGOR
Other - Middle Name:
Other - Last Name:KHELEMSKY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1041 ARCADIAN WAY
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6349
Mailing Address - Country:US
Mailing Address - Phone:718-376-3200
Mailing Address - Fax:
Practice Address - Street 1:2310 65TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-4088
Practice Address - Country:US
Practice Address - Phone:718-376-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1969632084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6774300Medicaid
NY01591322Medicaid
NYF96369Medicare UPIN
NJ6774300Medicaid
NJ801063Medicare ID - Type Unspecified