Provider Demographics
NPI:1487650073
Name:KHALEEL, ABDUL R (MD)
Entity Type:Individual
Prefix:
First Name:ABDUL
Middle Name:R
Last Name:KHALEEL
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 1:1168 BEACON AVE
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2418
Mailing Address - Country:US
Mailing Address - Phone:609-597-6092
Mailing Address - Fax:609-597-7458
Practice Address - Street 1:1168 BEACON AVE
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2418
Practice Address - Country:US
Practice Address - Phone:609-597-6092
Practice Address - Fax:609-597-7458
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-28
Last Update Date:2007-07-08
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
NJMA027674207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D06921Medicare UPIN
053422Medicare ID - Type Unspecified