Healthcare Provider Details

I. General information

NPI: 1376798454
Provider Name (Legal Business Name): SAIRAH KHOKHER M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 KYLE WAY
EWING NJ
08628-2516
US

IV. Provider business mailing address

19 KYLE WAY
EWING NJ
08628-2516
US

V. Phone/Fax

Practice location:
  • Phone: 609-323-7836
  • Fax:
Mailing address:
  • Phone: 609-323-7836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number25MA08974200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: