| NPI | 1578011177 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BORIS A KHAIMOV Physician 516-654-5551 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MB09860800) |
| Enumeration Date | 2016-09-13 |
| Last Update Date | 2016-09-13 |