Organization
TAREK R KHATER
Active
Other names
Tarek R Khater Medical Services
Organization subpart
No
Provider details
NPI number
Authorized official
TAREK R KHATER MD (OWENER)
(917) 960-0821
Entity
Organization
Contact information
Practice address
2814 31ST ST, SUITE 501, ASTORIA, NY 11102
(917) 960-0821
(713) 575-3865
Mailing address
PO BOX 672, NEW YORK, NY 10028-0044
(917) 960-0821
(646) 952-2004
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
261QR0208X
Mobile Radiology Clinic/Center
300724
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00093517
CCI
—
01
—
128919
MEDICAL LICENSE NYC MRC
NY
01
—
175911
ARDMS
—
01
—
3517284
DBA
NY
01
—
91504840501
AMA (ME#)
—
Enumeration date
02/29/2016
Last updated
08/08/2020
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