Provider Demographics
NPI:1184739799
Name:TATIANA KHROM, M.D., P.C.
Entity type:Organization
Organization Name:TATIANA KHROM, M.D., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TATIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHROM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-479-8039
Mailing Address - Street 1:2797 OCEAN PARKWAY
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-7868
Mailing Address - Country:US
Mailing Address - Phone:718-615-4000
Mailing Address - Fax:718-615-4004
Practice Address - Street 1:2797 OCEAN PKWY STE 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7868
Practice Address - Country:US
Practice Address - Phone:718-615-4000
Practice Address - Fax:718-615-4004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227196207N00000X, 207NS0135X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02804617Medicaid
NY02804617Medicaid
NYWLW271Medicare PIN