1750382834 NPI number — DR. OMAR S KHOKHAR MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750382834 NPI number — DR. OMAR S KHOKHAR MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

KHOKHAR

Provider First Name:

OMAR

Provider Middle Name:

S

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1750382834

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

01/28/2011

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 265

Provider Second Line Business Mailing Address:

3325 E MAIN ST

Provider Business Mailing Address City Name:

ATTICA

Provider Business Mailing Address State Name:

NY

Provider Business Mailing Address Postal Code:

14011-0265

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

585-591-0800

Provider Business Mailing Address Fax Number:

585-591-4204

Provider First Line Business Practice Location Address:

3325 E MAIN STREET RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

ATTICA

Provider Business Practice Location Address State Name:

NY

Provider Business Practice Location Address Postal Code:

14011-9506

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

585-591-0800

Provider Business Practice Location Address Fax Number:

585-591-4204

Provider Enumeration Date:

08/10/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208D00000X , with the licence number:  140294 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 00010090701 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 00633078 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
• Identifier: P010140294 . This is a "PREMIER HELATH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 000607913003 . This is a "BLUE CROSS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 0101478 . This is a "INDH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 4301608 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 1402941 . This is a "SATE INS FUND" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 161166300 . This is a "EMPIRE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 0047126 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 010065467 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 1402940 . This is a "WORKERS COMPENSATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".