Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 174872 | NY |
NPI | 1013901370 |
---|---|
Provider Name | Mazen T Khalifeh |
First Address | Mount Kisco, NY 10549-3417 |
Second Address | Mount Kisco, NY 10549-3417 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000013799 | GHI-HMO (01) | |
0051108 | AETNA-HMO (01) | |
01273578 | (05) | NY |
100986380-T816 | CDPHP PROVIDER NUMBER (01) | |
1291474 | UNITED HEALTHCARE PIN # (01) | |
1305499 | FIRST HEALTH-COVENTRY (01) | |
1999886 | GHI-PPO (01) | |
414789 | MVP HEALTHPLAN (01) | |
4323190 | AETNA PPO (01) | |
5C5441 | HEALTHNET (01) | |
89F251 | EMPIRE BC-BS (01) | |
E94739 | (02) | |
WS1315 | OXFORD (01) |