Provider Demographics
NPI:1215012901
Name:KHAN, ALTAF (MD)
Entity Type:Individual
Prefix:
First Name:ALTAF
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 1:267-01 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1743
Mailing Address - Country:US
Mailing Address - Phone:718-343-7790
Mailing Address - Fax:718-343-7792
Practice Address - Street 1:104-37 LEFFERTS BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-2709
Practice Address - Country:US
Practice Address - Phone:718-322-8494
Practice Address - Fax:718-322-8495
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY117571207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB78562Medicare UPIN
NY642291Medicare ID - Type Unspecified