Provider Demographics
NPI:1376655043
Name:KHOKHAR, ASIM S (MD)
Entity Type:Individual
Prefix:
First Name:ASIM
Middle Name:S
Last Name:KHOKHAR
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 1:135 AVALON CIR
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3870
Mailing Address - Country:US
Mailing Address - Phone:631-406-6503
Mailing Address - Fax:
Practice Address - Street 1:3 TECHNOLOGY DR
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-4064
Practice Address - Country:US
Practice Address - Phone:631-444-5220
Practice Address - Fax:631-444-5225
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA224786207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology