Provider Demographics
NPI:1245523513
Name:ITRIYEVA, KHALIDA (MD)
Entity type:Individual
Prefix:DR
First Name:KHALIDA
Middle Name:
Last Name:ITRIYEVA
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 1:10525 67TH RD APT 5H
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2398
Mailing Address - Country:US
Mailing Address - Phone:201-207-1196
Mailing Address - Fax:
Practice Address - Street 1:410 LAKEVILLE RD STE 108
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042
Practice Address - Country:US
Practice Address - Phone:516-465-3270
Practice Address - Fax:516-465-5299
Is Sole Proprietor?:No
Enumeration Date:2011-05-19
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2665492080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine