Provider Demographics
NPI:1225560469
Name:KHAN, ALI SHAH (MD)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:SHAH
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:HSC LEVEL 4 ROOM 080 STONY BROOK HOSPITAL
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-0001
Mailing Address - Country:US
Mailing Address - Phone:631-444-3880
Mailing Address - Fax:631-444-3919
Practice Address - Street 1:HSC LEVEL 4 ROOM 080 STONY BROOK HOSPITAL
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-444-3880
Practice Address - Fax:631-444-3919
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390200000X
NY304949207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program