Provider Demographics
NPI:1013901370
Name:KHALIFEH, MAZEN T (MD)
Entity Type:Individual
Prefix:
First Name:MAZEN
Middle Name:T
Last Name:KHALIFEH
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 1:400 E MAIN ST
Mailing Address - Street 2:NORTHERN WESTCHESTER HOSPITAL
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3417
Mailing Address - Country:US
Mailing Address - Phone:914-666-1862
Mailing Address - Fax:914-666-1444
Practice Address - Street 1:400 E MAIN ST
Practice Address - Street 2:NORTHERN WESTCHESTER HOSPITAL
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3417
Practice Address - Country:US
Practice Address - Phone:914-666-1862
Practice Address - Fax:914-666-1444
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1748722080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01273578Medicaid
1305499OtherFIRST HEALTH-COVENTRY
000000013799OtherGHI-HMO
0051108OtherAETNA-HMO
4323190OtherAETNA PPO
5C5441OtherHEALTHNET
WS1315OtherOXFORD
414789OtherMVP HEALTHPLAN
100986380-T816OtherCDPHP PROVIDER NUMBER
89F251OtherEMPIRE BC-BS
1291474OtherUNITED HEALTHCARE PIN #
1999886OtherGHI-PPO
NY01273578Medicaid