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General NPI Number Information
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NPI Number | 1598898421
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Entity Type | Individual
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Provider Name | GAUTAM KAUSHIK KHAKHAR M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3815 PUTNAM AVE W
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City | BRONX
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State | NY
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Zip | 10463-2442
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Country | US
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Telephone | 718-549-7260
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Fax |
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Provider Business Mailing Address
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Address Line | 171 E 84TH ST APT 21J
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City | NEW YORK
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State | NY
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Zip | 10028-2000
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Country | US
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Telephone | 917-208-6877
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 218201
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License Number State | NY
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