Individual
DIANA KHAIMOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
327 BEACH 19TH ST, FAR ROCKAWAY, NY 11691-4423
(718) 869-7000
Mailing address
327 BEACH 19TH ST, FAR ROCKAWAY, NY 11691-4423
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
022914-1
NY
Other
Enumeration date
11/26/2018
Last updated
11/26/2018
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