Provider Demographics
NPI:1619110277
Name:ABDUL ALI KHUWAJA.PHYSICIAN PC
Entity Type:Organization
Organization Name:ABDUL ALI KHUWAJA.PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:KHUWAJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-777-1998
Mailing Address - Street 1:45 05 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-1625
Mailing Address - Country:US
Mailing Address - Phone:718-777-1998
Mailing Address - Fax:718-777-5368
Practice Address - Street 1:45 05 BROADWAY
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-1625
Practice Address - Country:US
Practice Address - Phone:718-777-1998
Practice Address - Fax:718-777-5368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-13
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145342207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00955931Medicaid
NY145342-01OtherNEIGHBORHOOD HEALTH PROVIDERS
NY370140OtherHIP HEALTH PLANS
NY392782241OtherCIGNA
NY110155763OtherRAILROAD MEDICARE
NY145342B2OtherHEALTH FIRST
NY0031763OtherGROUP HEALTH INSURANCE
NYDS343OtherOXFORD HEALTH PLANS
NY91F521OtherEMPIRE BLUE CROSS AND BLUE SHEILD
NYG100000309Medicare PIN
NY145342B2OtherHEALTH FIRST
NYA100001462Medicare PIN
NY91F521OtherEMPIRE BLUE CROSS AND BLUE SHEILD