1619110277 NPI number — ABDUL ALI KHUWAJA.PHYSICIAN PC

Table of content: (NPI 1619110277)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619110277 NPI number — ABDUL ALI KHUWAJA.PHYSICIAN PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABDUL ALI KHUWAJA.PHYSICIAN PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619110277
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45 05 BROADWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASTORIA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11103-1625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-777-1998
Provider Business Mailing Address Fax Number:
718-777-5368

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45 05 BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASTORIA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11103-1625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-777-1998
Provider Business Practice Location Address Fax Number:
718-777-5368
Provider Enumeration Date:
04/13/2009

Additional Information

Authorized Official

Authorized Official Last Name:
KHUWAJA
Authorized Official First Name:
ABDUL
Authorized Official Middle Name:
ALI
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
718-777-1998

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  145342 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: 145342 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00955931 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 145342-01 . This is a "NEIGHBORHOOD HEALTH PROVIDERS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 370140 . This is a "HIP HEALTH PLANS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 392782241 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 110155763 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 145342B2 . This is a "HEALTH FIRST" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0031763 . This is a "GROUP HEALTH INSURANCE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: DS343 . This is a "OXFORD HEALTH PLANS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 91F521 . This is a "EMPIRE BLUE CROSS AND BLUE SHEILD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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