Provider Demographics
NPI:1982610028
Name:KHALID, NAZNEEN (MD)
Entity Type:Individual
Prefix:
First Name:NAZNEEN
Middle Name:
Last Name:KHALID
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:PO BOX 40110
Mailing Address - Street 2:
Mailing Address - City:GLEN OAKS
Mailing Address - State:NY
Mailing Address - Zip Code:11004-0110
Mailing Address - Country:US
Mailing Address - Phone:917-742-8283
Mailing Address - Fax:
Practice Address - Street 1:21838 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-1916
Practice Address - Country:US
Practice Address - Phone:718-465-7746
Practice Address - Fax:718-465-9911
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188568207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01624602Medicaid
NY66K901Medicare ID - Type Unspecified
NY01624602Medicaid