Provider Demographics
NPI:1790821395
Name:KHOKHAR, AZHAR IQBAL (MD)
Entity Type:Individual
Prefix:
First Name:AZHAR
Middle Name:IQBAL
Last Name:KHOKHAR
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 1:109 BUTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4834
Mailing Address - Country:US
Mailing Address - Phone:631-761-2365
Mailing Address - Fax:631-761-3680
Practice Address - Street 1:109 BUTTONWOOD DR
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-4834
Practice Address - Country:US
Practice Address - Phone:631-761-2365
Practice Address - Fax:631-761-3680
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2486132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300000233Medicare PIN