Provider Demographics
NPI:1487631909
Name:KHEDER, ABDUL-HADY (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDUL-HADY
Middle Name:
Last Name:KHEDER
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 1:445 WHITEHORSE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08610-1410
Mailing Address - Country:US
Mailing Address - Phone:609-585-1122
Mailing Address - Fax:609-585-0309
Practice Address - Street 1:445 WHITEHORSE AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08610-1408
Practice Address - Country:US
Practice Address - Phone:609-585-1122
Practice Address - Fax:609-585-0309
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA071489207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8401209Medicaid
NJ042775Medicare ID - Type Unspecified
NJ8401209Medicaid