Healthcare Provider Details

I. General information

NPI: 1104807601
Provider Name (Legal Business Name): KHALIFA HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 ROUTE 376 NESHEIWAT SQUARE SUITE Q
WAPPINGERS FALLS NY
12590-6377
US

IV. Provider business mailing address

900 ROUTE 376 NESHEIWAT SQUARE SUITE Q
WAPPINGERS FALLS NY
12590-6377
US

V. Phone/Fax

Practice location:
  • Phone: 845-223-8003
  • Fax: 845-223-9933
Mailing address:
  • Phone: 845-223-8003
  • Fax: 845-223-9933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number026106
License Number StateNY

VIII. Authorized Official

Name: ENGY KHALIFA
Title or Position: OFFICER
Credential:
Phone: 845-223-8003