Provider Demographics
NPI:1154492734
Name:KHAN, RIZWAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:RIZWAN
Middle Name:A
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1360 48TH ST
Mailing Address - Street 2:C2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-5262
Mailing Address - Country:US
Mailing Address - Phone:718-435-7664
Mailing Address - Fax:
Practice Address - Street 1:760 BROADWAY
Practice Address - Street 2:3A-30
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-5317
Practice Address - Country:US
Practice Address - Phone:718-963-8496
Practice Address - Fax:718-963-8501
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY227088207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY227088OtherNYS LICENSE