Active NPI
Marina Khaimova
- Physical Therapy Assistant
- Rego Park, NY
National Provider Identifier
1932566304
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 010258
- Practice address
- 6326B Bourton St
1B
Rego Park, NY 11374-2842 - Phone
- (917) 667-4271
- NPI assigned
- Jan 15, 2016
- Sex
- Female
- Sole proprietor
- Yes
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 Therapy Assistant | 225200000X | 010258 | NY | Primary |
Addresses
Primary practice location
6326B Bourton St
1B
Rego Park, NY 11374-2842
Mailing address
6326B Bourton St
1B
Rego Park, NY 11374-2842
Phone (917) 667-4271
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 |
|---|---|---|---|
| 010258 | NY | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1452816000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1452816000000",
"number": "1932566304",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6326B BOURTON ST",
"address_2": "1B",
"city": "REGO PARK",
"state": "NY",
"postal_code": "113742842",
"telephone_number": "917-667-4271"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6326B BOURTON ST",
"address_2": "1B",
"city": "REGO PARK",
"state": "NY",
"postal_code": "113742842",
"telephone_number": "917-667-4271"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHAIMOVA",
"first_name": "MARINA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-01-15",
"last_updated": "2016-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "NY",
"license": "010258",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rego Park, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.