Active NPI
Emmanuel Khanimov
- General Practice Dentistry
- Brooklyn, NY
National Provider Identifier
1386149201
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 060405
- Practice address
- 1492 E 18TH St
Brooklyn, NY 11230-6706 - Phone
- (718) 737-8324
- NPI assigned
- Mar 25, 2018
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 060405 | NY | Primary |
Addresses
Primary practice location
1492 E 18TH St
Brooklyn, NY 11230-6706
Mailing address
1492 E 18TH St
Brooklyn, NY 11230-6706
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180921000145 | NY | Order and Referring Only - Dentist | 1254682891 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 060405 | NY | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1521936000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1590192000000",
"number": "1386149201",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1492 E 18TH ST",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112306706"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1492 E 18TH ST",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112306706",
"telephone_number": "718-737-8324"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHANIMOV",
"first_name": "EMMANUEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-03-25",
"last_updated": "2020-05-23",
"certification_date": "2020-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NY",
"license": "060405",
"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 May 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.