Provider Demographics
NPI:1942987649
Name:KHALIQ, ALI
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:KHALIQ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 1ST AVE APT 525
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6444
Mailing Address - Country:US
Mailing Address - Phone:516-841-4818
Mailing Address - Fax:
Practice Address - Street 1:1955 1ST AVE APT 525
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6444
Practice Address - Country:US
Practice Address - Phone:516-841-4818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program