Provider Demographics
NPI:1730157587
Name:KHAWAJA, AFTAB A (MD)
Entity type:Individual
Prefix:DR
First Name:AFTAB
Middle Name:A
Last Name:KHAWAJA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:142 PALISADE AVE
Mailing Address - Street 2:STE 108
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-1133
Mailing Address - Country:US
Mailing Address - Phone:201-795-0101
Mailing Address - Fax:201-795-3550
Practice Address - Street 1:142 PALISADE AVE
Practice Address - Street 2:STE 108
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1133
Practice Address - Country:US
Practice Address - Phone:201-795-0101
Practice Address - Fax:201-795-3550
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02713900208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2548003Medicaid
NJ2548003Medicaid
NJ573403Medicare ID - Type Unspecified