Organization
PROKHOROV'S PEDIATRICS AND CHILD NEUROLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SVETLANA PROKHOROVA MD (PRESIDENT)
(718) 938-8762
Entity
Organization
Contact information
Practice address
9817 QUEENS BLVD, LL2, REGO PARK, NY 11374-3336
(718) 275-5600
(718) 275-5608
Mailing address
9817 QUEENS BLVD, LL2, REGO PARK, NY 11374-3336
(718) 275-5600
(718) 275-5608
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
—
—
Other
Enumeration date
08/20/2010
Last updated
06/03/2011
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