Individual
ELLA KHAIMOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
63-55 102 STREET, REGO PARK, NY 11374
(917) 698-4105
Mailing address
99-60 63 RD APT 1C, REGO PARK, NY 11374
(917) 698-4105
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
596457-1
NY
Other
Enumeration date
03/04/2014
Last updated
03/04/2014
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