Provider Demographics
NPI:1194832808
Name:KHAN, MUHAMMAD J (MD)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:J
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 1:15 HIGHVIEW RD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-2105
Mailing Address - Country:US
Mailing Address - Phone:718-205-7400
Mailing Address - Fax:718-205-7400
Practice Address - Street 1:40-18 CASE STREET
Practice Address - Street 2:MAIN FLOOR
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373
Practice Address - Country:US
Practice Address - Phone:718-205-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196993208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01541666Medicaid
G90019Medicare UPIN
NY01541666Medicaid