Provider Demographics
NPI:1124190616
Name:KHANI, GHASSAN (MD)
Entity Type:Individual
Prefix:
First Name:GHASSAN
Middle Name:
Last Name:KHANI
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 1:255 STATE RT 3
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-3857
Mailing Address - Country:US
Mailing Address - Phone:201-866-3266
Mailing Address - Fax:201-866-0887
Practice Address - Street 1:255 STATE RT 3
Practice Address - Street 2:SUITE 202
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-3857
Practice Address - Country:US
Practice Address - Phone:201-866-3266
Practice Address - Fax:201-866-0887
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA034629208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery