Provider Demographics
NPI:1861838518
Name:AKHTAR, RADEEB (MD)
Entity Type:Individual
Prefix:DR
First Name:RADEEB
Middle Name:
Last Name:AKHTAR
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 1:6405 YELLOWSTONE BLVD PH 507
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1574
Mailing Address - Country:US
Mailing Address - Phone:646-266-1636
Mailing Address - Fax:
Practice Address - Street 1:230 W 17TH ST LBBY A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-5366
Practice Address - Country:US
Practice Address - Phone:212-206-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA134451207Q00000X
NY390200000X
NY290028207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program