MEDICARE: DR. RATESH KHILLAN M.D.

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	282N00000X	General Acute Care Hospital	003427	NY
2	207RH0003X	Hematology & Oncology Physician	266181	NY

General Provider Information

NPI Number	:	1588869374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RATESH KHILLAN M.D.

Provider Business Mailing Address
First Line	:	123 BACON RD
Second Line	:
City	:	OLD WESTBURY
State	:	NY
Zip	:	11568-1304
Country	:	US
Telephone Number	:	718-221-9999
Fax Number	:

Provider Business Practice Location Address
First Line	:	672 UTICA AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-2210
Country	:	US
Telephone Number	:	718-221-9999
Fax Number	:

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

Provider Enumeration Date	:	06/20/2007
Last Update Date	:	11/21/2022

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