Healthcare Provider Details

I. General information

NPI: 1205896800
Provider Name (Legal Business Name): FERDOUS KHANDKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7017 37TH AVE
JACKSON HEIGHTS NY
11372-3922
US

IV. Provider business mailing address

7017 37TH AVE
JACKSON HEIGHTS NY
11372-3922
US

V. Phone/Fax

Practice location:
  • Phone: 718-565-5600
  • Fax: 718-565-5686
Mailing address:
  • Phone: 718-565-5600
  • Fax: 718-565-5686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number225253
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: