Datikashvili, Teymuraz

Datikashvili, Teymuraz is an individual health care provider with primary practice located at 10825 63Rd Ave 1St Fl, Forest Hills NY 11375-1342. He recently has only one registered license in Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation, which is considered as his primary health care specialty. Datikashvili, Teymuraz can be contacted via phone (718) 896-2011.

Contact Information

Primary practice address
10825 63Rd Ave 1St Fl Forest Hills NY 11375-1342
Phone: (718) 896-2011
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation 208100000X 211676 New York

Profile Details

NPI number 1952353161
LBN Legal business name Datikashvili, Teymuraz
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 16th, 2006
Last updated May 19th, 2016 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1952353161 NPPES
New York Other G100007358 MEDICARE GROUP PTAN

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