Provider Demographics
NPI:1265672489
Name:ISHRAT S. KHAN, M.D.,P.C.
Entity Type:Organization
Organization Name:ISHRAT S. KHAN, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ISHRAT
Authorized Official - Middle Name:S
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-794-9198
Mailing Address - Street 1:572 WAVERLY PL
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-4009
Mailing Address - Country:US
Mailing Address - Phone:516-794-9198
Mailing Address - Fax:
Practice Address - Street 1:142-18 38TH AVE STE CFD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5554
Practice Address - Country:US
Practice Address - Phone:718-886-2288
Practice Address - Fax:718-886-1179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-27
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147087208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C11121Medicare UPIN