MEDICARE: BILKICH KHANUM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	1234	NY

General Provider Information

NPI Number	:	1245962281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BILKICH KHANUM

Provider Business Mailing Address
First Line	:	2680 BRIGGS AVE APT 2ND
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-4082
Country	:	US
Telephone Number	:	518-207-8347
Fax Number	:

Provider Business Practice Location Address
First Line	:	2680 BRIGGS AVE APT 2ND
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-4082
Country	:	US
Telephone Number	:	518-207-8347
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2022
Last Update Date	:	06/28/2022

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Directions to “ BILKICH KHANUM ” Practice Location

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