Provider Demographics
NPI:1518131846
Name:OSMAN, KHALED A (DO)
Entity Type:Individual
Prefix:DR
First Name:KHALED
Middle Name:A
Last Name:OSMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37B HICKORY RD
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-1503
Mailing Address - Country:US
Mailing Address - Phone:516-263-5831
Mailing Address - Fax:
Practice Address - Street 1:2752 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4706
Practice Address - Country:US
Practice Address - Phone:718-769-9000
Practice Address - Fax:718-769-3002
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247810208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG30000034Medicare PIN