Provider Demographics
NPI:1750382834
Name:KHOKHAR, OMAR S (MD)
Entity type:Individual
Prefix:DR
First Name:OMAR
Middle Name:S
Last Name:KHOKHAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 265
Mailing Address - Street 2:3325 E MAIN ST
Mailing Address - City:ATTICA
Mailing Address - State:NY
Mailing Address - Zip Code:14011-0265
Mailing Address - Country:US
Mailing Address - Phone:585-591-0800
Mailing Address - Fax:585-591-4204
Practice Address - Street 1:3325 E MAIN STREET RD
Practice Address - Street 2:
Practice Address - City:ATTICA
Practice Address - State:NY
Practice Address - Zip Code:14011-9506
Practice Address - Country:US
Practice Address - Phone:585-591-0800
Practice Address - Fax:585-591-4204
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140294208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00010090701OtherUNIVERA
NY00633078Medicaid
NYP010140294OtherPREMIER HELATH PLAN
NY000607913003OtherBLUE CROSS
NY0101478OtherINDH
NY4301608OtherAETNA
NY1402941OtherSATE INS FUND
NY161166300OtherEMPIRE
NY0047126OtherGHI
NY010065467OtherRAILROAD MEDICARE
NY1402940OtherWORKERS COMPENSATION
NYP010140294OtherPREMIER HELATH PLAN
NY079133Medicare ID - Type Unspecified