Provider Demographics
NPI:1902595192
Name:KHWAJA, TAHA
Entity Type:Individual
Prefix:
First Name:TAHA
Middle Name:
Last Name:KHWAJA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 DUPONT ST APT 3A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-5572
Mailing Address - Country:US
Mailing Address - Phone:516-439-9497
Mailing Address - Fax:
Practice Address - Street 1:141 DUPONT ST APT 3A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-5572
Practice Address - Country:US
Practice Address - Phone:516-439-9497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health