Provider Demographics
NPI:1619402567
Name:KHAIRAT, ALI (MD)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:KHAIRAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 EAST 149TH STREET, 2C2 ROOM 445A
Mailing Address - Street 2:DEPARTMENT OF EMERGENCY MEDICINE,
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10451
Mailing Address - Country:US
Mailing Address - Phone:718-579-6011
Mailing Address - Fax:718-579-4822
Practice Address - Street 1:234 EAST 149TH STREET, 2C2 ROOM 445A
Practice Address - Street 2:DEPARTMENT OF EMERGENCY MEDICINE,
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10451
Practice Address - Country:US
Practice Address - Phone:718-579-6011
Practice Address - Fax:718-579-4822
Is Sole Proprietor?:No
Enumeration Date:2017-04-28
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NH20975207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program