Provider Demographics
NPI:1437335411
Name:MASOOD, KHALID (RPH)
Entity Type:Individual
Prefix:MR
First Name:KHALID
Middle Name:
Last Name:MASOOD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BIRCH CT
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-1305
Mailing Address - Country:US
Mailing Address - Phone:201-725-1451
Mailing Address - Fax:212-283-4777
Practice Address - Street 1:523 LENOX AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-1808
Practice Address - Country:US
Practice Address - Phone:201-725-1451
Practice Address - Fax:212-283-4777
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-21
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7008750001Medicare NSC