Healthcare Provider Details

I. General information

NPI: 1053153569
Provider Name (Legal Business Name): YOUNUS KHOKHAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2024
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 STONEGATE RD
BALLSTON LAKE NY
12019-9301
US

IV. Provider business mailing address

7 STONEGATE RD
BALLSTON LAKE NY
12019-9301
US

V. Phone/Fax

Practice location:
  • Phone: 518-281-4517
  • Fax:
Mailing address:
  • Phone: 518-506-1793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0206X
TaxonomyCardiology Pharmacist
License Number0000000
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: