Provider Demographics
NPI:1134190986
Name:KHAW, OMMER (MD)
Entity type:Individual
Prefix:DR
First Name:OMMER
Middle Name:
Last Name:KHAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 BURROUGHS WAY
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-1436
Mailing Address - Country:US
Mailing Address - Phone:212-737-3382
Mailing Address - Fax:212-737-3392
Practice Address - Street 1:205 E 76TH ST
Practice Address - Street 2:SUITE M-2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2147
Practice Address - Country:US
Practice Address - Phone:212-737-3382
Practice Address - Fax:212-737-3392
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220274207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02139715Medicaid
NY02139715Medicaid
NYH33995Medicare UPIN