Provider Demographics
NPI:1003105792
Name:KHAYYAL, USAMA (MD)
Entity Type:Individual
Prefix:DR
First Name:USAMA
Middle Name:
Last Name:KHAYYAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2936 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-2251
Mailing Address - Country:US
Mailing Address - Phone:347-396-5612
Mailing Address - Fax:
Practice Address - Street 1:2936 30TH AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-2251
Practice Address - Country:US
Practice Address - Phone:347-396-5612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-01
Last Update Date:2020-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303794208VP0000X, 208100000X, 208VP0000X
NJ25MA10775800208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine