Provider Demographics
NPI:1063442226
Name:KHUWAJA, ABDUL ALI (MD)
Entity Type:Individual
Prefix:
First Name:ABDUL
Middle Name:ALI
Last Name:KHUWAJA
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 1:4505 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-1625
Mailing Address - Country:US
Mailing Address - Phone:718-777-1998
Mailing Address - Fax:718-777-5368
Practice Address - Street 1:4505 BROADWAY
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-1625
Practice Address - Country:US
Practice Address - Phone:718-777-1998
Practice Address - Fax:718-777-5368
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145342207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA11585Medicare UPIN