Provider Demographics
NPI:1619075009
Name:BOKHARI, TAHIRA (MD)
Entity Type:Individual
Prefix:MRS
First Name:TAHIRA
Middle Name:
Last Name:BOKHARI
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 1:443 EAST WESTFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07204
Mailing Address - Country:US
Mailing Address - Phone:908-241-1611
Mailing Address - Fax:908-241-1644
Practice Address - Street 1:17-15 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410
Practice Address - Country:US
Practice Address - Phone:201-703-9447
Practice Address - Fax:201-703-9097
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA40419207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3231003Medicaid
NJ457472Medicare ID - Type Unspecified
NJ3231003Medicaid