Provider Demographics
NPI:1851617294
Name:ABDUL KHALIQ, P.C.
Entity Type:Organization
Organization Name:ABDUL KHALIQ, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:H
Authorized Official - Last Name:KHALIQ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-233-7210
Mailing Address - Street 1:45 S MAIN ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2441
Mailing Address - Country:US
Mailing Address - Phone:860-233-7210
Mailing Address - Fax:860-233-7724
Practice Address - Street 1:45 S MAIN ST
Practice Address - Street 2:SUITE 111
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2441
Practice Address - Country:US
Practice Address - Phone:860-233-7210
Practice Address - Fax:860-233-7724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-09
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT019793152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty