Active NPI
Dmitriy Khafizov
- Physical Therapist
- Brooklyn, NY
National Provider Identifier
1851930820
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 024523
- Practice address
- 1 Brookdale PLZ
Brooklyn, NY 11212-3139 - Phone
- (718) 240-5428
- NPI assigned
- Dec 23, 2019
- Last updated
- Dec 24, 2019
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 024523 | NY | Primary |
Addresses
Primary practice location
1 Brookdale PLZ
Brooklyn, NY 11212-3139
Mailing address
7319 195TH St
Fresh Meadows, NY 11366-1839
Phone (917) 945-5344
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 |
|---|---|---|---|
| 024523 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1577059200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1577145600000",
"number": "1851930820",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7319 195TH ST",
"city": "FRESH MEADOWS",
"state": "NY",
"postal_code": "113661839",
"telephone_number": "917-945-5344"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 BROOKDALE PLZ",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112123139",
"telephone_number": "718-240-5428"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHAFIZOV",
"first_name": "DMITRIY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-12-23",
"last_updated": "2019-12-24",
"certification_date": "2019-12-24",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "024523",
"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 Dec 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.