Healthcare Provider Details

I. General information

NPI: 1427382399
Provider Name (Legal Business Name): ISRAR KHANKHEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 BLOOMING GROVE TPKE
NEW WINDSOR NY
12553-7805
US

IV. Provider business mailing address

34 GREENWICH AVE
CENTRAL VALLEY NY
10917-3718
US

V. Phone/Fax

Practice location:
  • Phone: 845-269-1739
  • Fax:
Mailing address:
  • Phone: 845-269-1739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number254884
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number254884
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: