Individual
LASHA KHETSURIANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1500 WATERS PL, BRONX, NY 10461-2723
(718) 931-0600
Mailing address
3750 HUDSON MANOR TER # 3F, BRONX, NY 10463-1126
(347) 427-1718
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
235867
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
235867
—
NY
Enumeration date
03/20/2007
Last updated
07/08/2007
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