| Rena Khanukayeva D.o.,p.c. | |
|
2691 Hylan Blvd Suite # 5 Staten Island NY 10306-4300 | |
| (718) 980-3232 | |
| Not Available |
| Full Name | Rena Khanukayeva D.o.,p.c. |
|---|---|
| Speciality | Clinic/Center |
| Location | 2691 Hylan Blvd, Staten Island, New York |
| Authorized Official Name and Position | Rena Khanukayeva (PRESIDENT) |
| Authorized Official Contact | 7189803232 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rena Khanukayeva D.o.,p.c. 2691 Hylan Blvd Suite # 5 Staten Island NY 10306-3231 Ph: (718) 980-3232 | Rena Khanukayeva D.o.,p.c. 2691 Hylan Blvd Suite # 5 Staten Island NY 10306-4300 Ph: (718) 980-3232 |
| NPI Number | 1639370554 |
|---|---|
| Provider Enumeration Date | 05/29/2007 |
| Last Update Date | 07/13/2009 |
| Medicare PECOS PAC ID | 7416045133 |
|---|---|
| Medicare Enrollment ID | O20071114000182 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639370554 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 212257 (New York) | Primary |
| Provider Name | Rena Khanukayeva |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255358164 PECOS PAC ID: 4880688662 Enrollment ID: I20040413001886 |
| Provider Name | Zarina Pinkhasova |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053069930 PECOS PAC ID: 2668829482 Enrollment ID: I20231115002321 |
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