Provider Demographics
NPI:1619084696
Name:KHAWAJA, ASIA BANO (MD)
Entity Type:Individual
Prefix:
First Name:ASIA
Middle Name:BANO
Last Name:KHAWAJA
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 1:176 PALISADE AVE
Mailing Address - Street 2:CHRIST HOSPITAL LAB
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306
Mailing Address - Country:US
Mailing Address - Phone:201-795-5963
Mailing Address - Fax:201-795-8118
Practice Address - Street 1:176 PALISADE AVE
Practice Address - Street 2:CHRIST HOSPITAL LAB
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306
Practice Address - Country:US
Practice Address - Phone:201-795-5963
Practice Address - Fax:201-795-8118
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02775800207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1090402Medicaid
E22028Medicare UPIN
NJKH455702Medicare ID - Type Unspecified