Individual
KHADIJA TUL KUBRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6136 170TH ST, FRESH MEADOWS, NY 11365-1900
(718) 709-0940
Mailing address
6136 170TH ST, FRESH MEADOWS, NY 11365-1900
(718) 709-0940
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
P115363
NY
Other
Enumeration date
06/08/2022
Last updated
06/08/2022
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