Provider Demographics
NPI:1366419962
Name:PROKHOROV, SERGEY (MD)
Entity type:Individual
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First Name:SERGEY
Middle Name:
Last Name:PROKHOROV
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Gender:M
Credentials:MD
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Mailing Address - Street 1:9817 QUEENS BOULEVARD
Mailing Address - Street 2:LL2
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3336
Mailing Address - Country:US
Mailing Address - Phone:718-275-5600
Mailing Address - Fax:718-275-5608
Practice Address - Street 1:9817 QUEENS BOULEVARD
Practice Address - Street 2:LL2
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3336
Practice Address - Country:US
Practice Address - Phone:718-275-5600
Practice Address - Fax:718-275-5608
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2011-06-10
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Provider Licenses
StateLicense IDTaxonomies
NY2310082084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology