Provider Demographics
NPI:1003337700
Name:KHAN, MUZAMMIL (MD)
Entity Type:Individual
Prefix:
First Name:MUZAMMIL
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1554
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0988
Mailing Address - Country:US
Mailing Address - Phone:631-444-8478
Mailing Address - Fax:631-444-7546
Practice Address - Street 1:101 NICOLLS ROAD
Practice Address - Street 2:HSC T16-020
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8160
Practice Address - Country:US
Practice Address - Phone:631-444-8478
Practice Address - Fax:631-444-7546
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY307000208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist