Provider Demographics
NPI:1205896800
Name:KHANDKER, FERDOUS
Entity type:Individual
Prefix:
First Name:FERDOUS
Middle Name:
Last Name:KHANDKER
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 1:7017 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-3922
Mailing Address - Country:US
Mailing Address - Phone:718-565-5600
Mailing Address - Fax:718-565-5686
Practice Address - Street 1:7017 37TH AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-3922
Practice Address - Country:US
Practice Address - Phone:718-565-5600
Practice Address - Fax:718-565-5686
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225253173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02300407Medicaid
NY02300407Medicaid
NY117AS2Medicare ID - Type Unspecified