Healthcare Provider Details

I. General information

NPI: 1942473269
Provider Name (Legal Business Name): KHAMIS G KHAMIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 WILLIAMSON ST
ELIZABETH NJ
07202-3625
US

IV. Provider business mailing address

2828 CROASDAILE DR
DURHAM NC
27705-2505
US

V. Phone/Fax

Practice location:
  • Phone: 908-994-5000
  • Fax:
Mailing address:
  • Phone: 866-272-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number08322000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MA08322000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: