Organization
KASHYAR KHODABAKHSH M.D.P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RACHEL MIZRAHI (MANAGER)
(516) 487-5044
Entity
Organization
Contact information
Practice address
260 MIDDLE NECK RD APT 1E, GREAT NECK, NY 11021-1159
(516) 487-5044
Mailing address
350 NORTHERN BLVD STE 300, GREAT NECK, NY 11021-4809
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
NYS258356
NY
Other
Enumeration date
09/07/2017
Last updated
02/23/2018
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