Provider Demographics
NPI:1356307961
Name:KHAN, NAJMI SHAMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:NAJMI
Middle Name:SHAMIN
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 1:707 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2650
Mailing Address - Country:US
Mailing Address - Phone:845-333-3370
Mailing Address - Fax:845-333-3372
Practice Address - Street 1:707 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2650
Practice Address - Country:US
Practice Address - Phone:845-333-3370
Practice Address - Fax:845-333-3372
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14887R207R00000X
NY226113207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1445509Medicaid
7395473OtherAETNA
LA1151327Medicaid
G5437OtherBSBS AUTH #
189418OtherCOVENTRY
14887ROtherSTATE LIC #
14887ROtherSTATE LIC #
7395473OtherAETNA
G5437OtherBSBS AUTH #
H77935Medicare UPIN
LASC730Medicare ID - Type UnspecifiedGROUP #
LA5DH01Medicare PIN