Provider Demographics
NPI:1902999428
Name:LK BETTER HEALTH MEDICAL PC
Entity Type:Organization
Organization Name:LK BETTER HEALTH MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHASIDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-520-2300
Mailing Address - Street 1:11115 QUEENS BLVD
Mailing Address - Street 2:2ND FL
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:718-520-2300
Mailing Address - Fax:718-520-4440
Practice Address - Street 1:11115 QUEENS BLVD
Practice Address - Street 2:2ND FL
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-520-2300
Practice Address - Fax:718-520-4440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03210Medicare PIN