Provider Demographics
NPI:1104807601
Name:KHALIFA HEALTH INC
Entity type:Organization
Organization Name:KHALIFA HEALTH INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ENGY
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALIFA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-223-8003
Mailing Address - Street 1:900 ROUTE 376
Mailing Address - Street 2:NESHEIWAT SQUARE SUITE Q
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-6377
Mailing Address - Country:US
Mailing Address - Phone:845-223-8003
Mailing Address - Fax:845-223-9933
Practice Address - Street 1:900 ROUTE 376
Practice Address - Street 2:NESHEIWAT SQUARE SUITE Q
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-6377
Practice Address - Country:US
Practice Address - Phone:845-223-8003
Practice Address - Fax:845-223-9933
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH LINE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-10
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026106333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02415447Medicaid
NY02415447Medicaid