Provider Demographics
NPI:1013191261
Name:KHAWAJA, FAROOQ (BS)
Entity Type:Individual
Prefix:MR
First Name:FAROOQ
Middle Name:
Last Name:KHAWAJA
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 PLAINFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001
Mailing Address - Country:US
Mailing Address - Phone:516-775-5725
Mailing Address - Fax:
Practice Address - Street 1:1231 WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-3373
Practice Address - Country:US
Practice Address - Phone:718-618-0802
Practice Address - Fax:718-618-0804
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031750183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6479820001Medicare NSC