Healthcare Provider Details

I. General information

NPI: 1407119613
Provider Name (Legal Business Name): KHALIKA RAJA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 CONEY ISLAND AVE
BROOKLYN NY
11230-2340
US

IV. Provider business mailing address

1121 CONEY ISLAND AVE
BROOKLYN NY
11230-2340
US

V. Phone/Fax

Practice location:
  • Phone: 718-434-7100
  • Fax: 718-434-7120
Mailing address:
  • Phone: 718-434-7100
  • Fax: 718-434-7120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number282845
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: