MEDICARE: ALI KHAIRAT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207P00000X	Emergency Medicine Physician	20975	NH

General Provider Information

NPI Number	:	1619402567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALI KHAIRAT M.D.

Provider Business Mailing Address
First Line	:	234 EAST 149TH STREET, 2C2 ROOM 445A
Second Line	:	DEPARTMENT OF EMERGENCY MEDICINE,
City	:	NEW YORK
State	:	NY
Zip	:	10451
Country	:	US
Telephone Number	:	718-579-6011
Fax Number	:	718-579-4822

Provider Business Practice Location Address
First Line	:	234 EAST 149TH STREET, 2C2 ROOM 445A
Second Line	:	DEPARTMENT OF EMERGENCY MEDICINE,
City	:	NEW YORK
State	:	NY
Zip	:	10451
Country	:	US
Telephone Number	:	718-579-6011
Fax Number	:	718-579-4822

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2017
Last Update Date	:	03/01/2021

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