Provider Demographics
NPI:1477530012
Name:KHADEM, JOHN J (MD, MPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:KHADEM
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-7995
Mailing Address - Country:US
Mailing Address - Phone:212-604-9800
Mailing Address - Fax:212-242-4757
Practice Address - Street 1:20 W 13TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7995
Practice Address - Country:US
Practice Address - Phone:212-604-9800
Practice Address - Fax:212-242-4757
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-26
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219303207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology