Provider Demographics
NPI:1932917002
Name:MUNTASIR KHALED, DPM LLC
Entity type:Organization
Organization Name:MUNTASIR KHALED, DPM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUNTASIR
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-873-0211
Mailing Address - Street 1:131 COLUMBIA TPKE STE 2B
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-2181
Mailing Address - Country:US
Mailing Address - Phone:973-873-0211
Mailing Address - Fax:
Practice Address - Street 1:131 COLUMBIA TPKE STE 2B
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-2181
Practice Address - Country:US
Practice Address - Phone:973-873-0211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MUNTASIR KHALED, DPM LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty