Provider Demographics
NPI:1538496427
Name:KHANEJA, SAROJ (MD)
Entity Type:Individual
Prefix:DR
First Name:SAROJ
Middle Name:
Last Name:KHANEJA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 CAPTAINS RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-2807
Mailing Address - Country:US
Mailing Address - Phone:516-677-4062
Mailing Address - Fax:
Practice Address - Street 1:96 CAPTAINS RD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-2807
Practice Address - Country:US
Practice Address - Phone:516-677-4062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121578-1207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY121578-1OtherNEW YORK STATE MEDICAL LICENSE