Provider Demographics
NPI:1467899898
Name:KHALIFA, DANIAL (DPM)
Entity Type:Individual
Prefix:DR
First Name:DANIAL
Middle Name:
Last Name:KHALIFA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 ROUTE 70
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:NJ
Mailing Address - Zip Code:08759-1003
Mailing Address - Country:US
Mailing Address - Phone:732-202-3000
Mailing Address - Fax:
Practice Address - Street 1:1100 ROUTE 70
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:NJ
Practice Address - Zip Code:08759-1003
Practice Address - Country:US
Practice Address - Phone:732-202-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
NJ25MAD00330800213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program