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General NPI Number Information
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NPI Number | 1720456049
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Entity Type | Individual
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Provider Name | TAREK R KHATER M.D.,
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Gender | Male
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Dates
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Enumeration Date | 09/02/2015
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Last Update Date | 08/08/2020
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Provider Practice Location Address
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Address Line | 229 E 85TH ST 672
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City | NEW YORK
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State | NY
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Zip | 10028-9600
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Country | US
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Telephone | 917-960-0821
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Fax | 646-952-2004
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Provider Business Mailing Address
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Address Line | 229 E 85TH ST 672
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City | NEW YORK
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State | NY
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Zip | 10028-9600
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Country | US
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Telephone | 917-960-0821
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Fax | 646-952-2004
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 2010966 PTAL
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 246XS1301X
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Taxonomy Name | Sonography Specialist/Technologist Cardiovascular
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License Number | CCI: 00093517
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 2471S1302X
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Taxonomy Name | Sonography Radiologic Technologist
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License Number | ARDMS: 176911
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 128919
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License Number State | NY
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