Individual
MR. DMITRY KHASAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
77 PARK AVE, NEW YORK, NY 10016-2556
(212) 826-6999
(201) 626-4041
Mailing address
PO BOX 6656, DMITRY KHASAK MD, NEW YORK, NY 10150
(201) 626-4040
(201) 626-4041
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
1940541
NY
207N00000X
Dermatology Physician
25MA06377000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01867481
—
NY
Enumeration date
01/04/2006
Last updated
06/17/2014
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