Provider Demographics
NPI:1164316774
Name:KHAIMOV, NATALIE
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:KHAIMOV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8509 RADNOR ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA ESTATES
Mailing Address - State:NY
Mailing Address - Zip Code:11432-2325
Mailing Address - Country:US
Mailing Address - Phone:917-476-0380
Mailing Address - Fax:
Practice Address - Street 1:8509 RADNOR ST
Practice Address - Street 2:
Practice Address - City:JAMAICA ESTATES
Practice Address - State:NY
Practice Address - Zip Code:11432-2325
Practice Address - Country:US
Practice Address - Phone:917-476-0380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1908620251103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst