Provider Demographics
NPI:1346754132
Name:DR KHALED AL ALWANI PC
Entity Type:Organization
Organization Name:DR KHALED AL ALWANI PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:KHALED
Authorized Official - Middle Name:
Authorized Official - Last Name:AL ALWANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-545-7962
Mailing Address - Street 1:14 EMERSON DR
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-1511
Mailing Address - Country:US
Mailing Address - Phone:347-545-7962
Mailing Address - Fax:
Practice Address - Street 1:50 BARKALOW AVE
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2064
Practice Address - Country:US
Practice Address - Phone:347-345-5812
Practice Address - Fax:347-345-5812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty