Provider Demographics
NPI:1396762944
Name:AHMED-KHOKHAR, MAHEEN (MSC)
Entity type:Individual
Prefix:
First Name:MAHEEN
Middle Name:
Last Name:AHMED-KHOKHAR
Suffix:
Gender:F
Credentials:MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 406153
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1876
Mailing Address - Country:US
Mailing Address - Phone:973-538-1609
Mailing Address - Fax:973-538-0432
Practice Address - Street 1:24 PINE ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-9434
Practice Address - Country:US
Practice Address - Phone:973-538-1609
Practice Address - Fax:973-538-0432
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJYA00597231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ161756Q6XMedicare PIN
NJ071141Q6X.Medicare PIN