Provider Demographics
NPI:1265448682
Name:KHANIJO, SARITA (MD)
Entity Type:Individual
Prefix:DR
First Name:SARITA
Middle Name:
Last Name:KHANIJO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SARITA
Other - Middle Name:
Other - Last Name:VAID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:275 HELM LN
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8118
Mailing Address - Country:US
Mailing Address - Phone:631-968-6368
Mailing Address - Fax:631-968-1317
Practice Address - Street 1:45 W SUFFOLK AVE
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-2143
Practice Address - Country:US
Practice Address - Phone:631-853-2710
Practice Address - Fax:631-853-3595
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168955207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE77493Medicare UPIN