Provider Demographics
NPI:1083653521
Name:KHENY, MIRA (MD)
Entity Type:Individual
Prefix:
First Name:MIRA
Middle Name:
Last Name:KHENY
Suffix:
Gender:F
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:PO BOX 1077
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-7077
Mailing Address - Country:US
Mailing Address - Phone:856-910-8100
Mailing Address - Fax:856-910-8101
Practice Address - Street 1:1 BRACE RD STE B2
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2600
Practice Address - Country:US
Practice Address - Phone:856-354-2232
Practice Address - Fax:856-375-6236
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04506900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine