Provider Demographics
NPI:1932675881
Name:ABOOLATIFF, KHATEEJA (MBBS)
Entity Type:Individual
Prefix:MISS
First Name:KHATEEJA
Middle Name:
Last Name:ABOOLATIFF
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 CLARKSON AVENUE, P-O 1229
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203
Mailing Address - Country:US
Mailing Address - Phone:718-270-2078
Mailing Address - Fax:718-270-1985
Practice Address - Street 1:450 CLARKSON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203
Practice Address - Country:US
Practice Address - Phone:718-270-2078
Practice Address - Fax:718-270-1985
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-18
Last Update Date:2019-07-15
Deactivation Date:2019-05-31
Deactivation Code:
Reactivation Date:2019-07-12
Provider Licenses
StateLicense IDTaxonomies
NMRS2018-0868390200000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program