Provider Demographics
NPI:1174836365
Name:KHAN, EZZA ASLAM (MD)
Entity Type:Individual
Prefix:
First Name:EZZA
Middle Name:ASLAM
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 STATE ROUTE 31 STE 300
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-5744
Mailing Address - Country:US
Mailing Address - Phone:908-788-6474
Mailing Address - Fax:908-788-6474
Practice Address - Street 1:121 STATE ROUTE 31 STE 300
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-5744
Practice Address - Country:US
Practice Address - Phone:908-788-6474
Practice Address - Fax:908-788-6616
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09938500207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease