Individual
KHATIYA CHELIDZE MOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
7559 263RD ST, GLEN OAKS, NY 11004-1150
(718) 470-8005
Mailing address
7559 263RD ST, GLEN OAKS, NY 11004-1150
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
305068
NY
Other
Enumeration date
03/31/2018
Last updated
06/30/2022
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