Provider Demographics
NPI:1801475223
Name:MUNTASIR KHALED, DPM LLC
Entity type:Organization
Organization Name:MUNTASIR KHALED, DPM LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MUNTASIR
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALED
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-873-0211
Mailing Address - Street 1:309 MEMORIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-4264
Mailing Address - Country:US
Mailing Address - Phone:973-873-0211
Mailing Address - Fax:973-588-3119
Practice Address - Street 1:309 MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-4264
Practice Address - Country:US
Practice Address - Phone:973-570-8819
Practice Address - Fax:973-588-3119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-04
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty