Active NPI
Alexander Khudysh, R.R.A
- Physician Assistant
- Brooklyn, NY
National Provider Identifier
1023315538
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 000179
- Practice address
- 2815 Coyle St Apt 611
Brooklyn, NY 11235-1742 - Phone
- (413) 636-2919
- NPI assigned
- Feb 17, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 000179 | NY | Primary |
Addresses
Primary practice location
2815 Coyle St Apt 611
Brooklyn, NY 11235-1742
Mailing address
2815 Coyle St Apt 611
Brooklyn, NY 11235-1742
Phone (413) 636-2919
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000179 | NY | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1297900800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1297900800000",
"number": "1023315538",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2815 COYLE ST APT 611",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112351742",
"telephone_number": "413-636-2919"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2815 COYLE ST APT 611",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112351742",
"telephone_number": "413-636-2919"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHUDYSH",
"first_name": "ALEXANDER",
"name_prefix": "Mr.",
"credential": "R.R.A",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-02-17",
"last_updated": "2011-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "000179",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.