Provider Demographics
NPI:1558701524
Name:ALALWANI, KHALED (MD)
Entity Type:Individual
Prefix:
First Name:KHALED
Middle Name:
Last Name:ALALWANI
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 1:14 EMERSON DR
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-1511
Mailing Address - Country:US
Mailing Address - Phone:718-720-2377
Mailing Address - Fax:
Practice Address - Street 1:57 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-4041
Practice Address - Country:US
Practice Address - Phone:347-545-7962
Practice Address - Fax:862-591-1194
Is Sole Proprietor?:No
Enumeration Date:2013-07-05
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY286078207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA09983000OtherNJ LICENSE /REGISTRATION CERTIFICATE