Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 262661 | NY |
Y | 2080P0205X | Pediatric Endocrinologist | 25MA09622900 | NJ |
N | 2080P0205X | Pediatric Endocrinologist | 262661 | NY |
NPI | 1265736268 |
---|---|
Provider Name | Ahmed Khattab |
First Address | Philadelphia, PA 19182-9642 |
Second Address | New Brunswick, NJ 08901-1935 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2011 |
Last Update Date | 23/07/2021 |