Healthcare Provider Details

I. General information

NPI: 1558707158
Provider Name (Legal Business Name): KHATIJA NAZIR BUKHARI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 1ST AVE
ORANGEBURG NY
10962-1106
US

IV. Provider business mailing address

66 HIGHRIDGE RD
HARTSDALE NY
10530-3605
US

V. Phone/Fax

Practice location:
  • Phone: 845-680-4000
  • Fax:
Mailing address:
  • Phone: 718-701-3285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number267060
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: