Provider Demographics
NPI:1285651109
Name:KAID, KHALIL AHMED
Entity Type:Individual
Prefix:DR
First Name:KHALIL
Middle Name:AHMED
Last Name:KAID
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2168 MILLBURN AVE
Mailing Address - Street 2:STE 205
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-2670
Mailing Address - Country:US
Mailing Address - Phone:973-762-3353
Mailing Address - Fax:973-762-3370
Practice Address - Street 1:2168 MILLBURN AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-2640
Practice Address - Country:US
Practice Address - Phone:973-762-3353
Practice Address - Fax:973-762-3370
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08008500207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ91002856200OtherAMERICHOICE
NJ0107310Medicaid
NJ103517TM8Medicare PIN
NJ103517UXXMedicare PIN
NJ103517S6SMedicare PIN