Provider Demographics
NPI:1598898421
Name:KHAKHAR, GAUTAM KAUSHIK (MD)
Entity Type:Individual
Prefix:DR
First Name:GAUTAM
Middle Name:KAUSHIK
Last Name:KHAKHAR
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 1:171 E 84TH ST
Mailing Address - Street 2:APT 21J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-2000
Mailing Address - Country:US
Mailing Address - Phone:917-208-6877
Mailing Address - Fax:
Practice Address - Street 1:3815 PUTNAM AVE W
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-2442
Practice Address - Country:US
Practice Address - Phone:718-549-7260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2182012081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine