Healthcare Provider Details

I. General information

NPI: 1568622397
Provider Name (Legal Business Name): KHALID SAIFULLAH AHMAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 BLUE POINT RD
FARMINGVILLE NY
11738-1839
US

IV. Provider business mailing address

465 BLUE POINT RD
FARMINGVILLE NY
11738-1839
US

V. Phone/Fax

Practice location:
  • Phone: 631-495-1962
  • Fax: 631-615-1043
Mailing address:
  • Phone: 631-495-1962
  • Fax: 631-615-1043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number254147
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number254147
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License Number254147
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: