Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | 261646 | NY |
NPI | 1174788541 |
---|---|
Provider Name | Haider Ali Khadim |
First Address | North Tonawanda, NY 14120-2019 |
Second Address | Cheektowaga, NY 14225-2591 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2008 |
Last Update Date | 16/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03358981 | (05) | NY |