Healthcare Provider Details

I. General information

NPI: 1134913098
Provider Name (Legal Business Name): AISHA KHAYYAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E 31ST ST FL B12
NEW YORK NY
10016-6333
US

IV. Provider business mailing address

222 E 31ST ST # B12
NEW YORK NY
10016-6333
US

V. Phone/Fax

Practice location:
  • Phone: 315-201-0621
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number333881
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: