Khaldarov, Vitaliy

Khaldarov, Vitaliy is an sole proprietor health care provider with primary practice located at 19615 75Th Ave , Flushing NY 11366-1813. He recently has only one registered license in Allopathic & Osteopathic Physicians / Psychiatry, which is considered as his primary health care specialty. Khaldarov, Vitaliy can be contacted via phone (917) 816-4597.

Contact Information

Primary practice address
19615 75Th Ave Flushing NY 11366-1813
Phone: (917) 816-4597
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 218084 New York

Profile Details

NPI number 1609851195
LBN Legal business name Khaldarov, Vitaliy
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 7th, 2005
Last updated May 27th, 2010 - about 16 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 1609851195 NPPES
New York Other 464106 VALUE OPTION
New York Other 581076 VALUE OPTION
New York MEDICAID 02119253 VALUE OPTION
New York Other P2574904 VALUE OPTION

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