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General NPI Number Information
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NPI Number | 1780261891
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Entity Type | Individual
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Provider Name | ELIAS ISHAN KHWAJA MD
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Gender | Male
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Dates
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Enumeration Date | 03/25/2021
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 1231 DEER PARK AVE
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City | NORTH BABYLON
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State | NY
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Zip | 11703-3104
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Country | US
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Telephone | 631-667-0388
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Fax | 631-968-7705
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Provider Business Mailing Address
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Address Line | 119 OAKFIELD DR
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City | BRANDON
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State | FL
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Zip | 33511-5779
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Country | US
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Telephone |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 330996
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License Number State | NY
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