Provider Demographics
NPI:1376535252
Name:KHAN, TABASSUM YASMIN (MD)
Entity Type:Individual
Prefix:
First Name:TABASSUM
Middle Name:YASMIN
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1328
Mailing Address - Country:US
Mailing Address - Phone:845-486-2703
Mailing Address - Fax:845-471-3406
Practice Address - Street 1:223 MAIN ST
Practice Address - Street 2:
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-2770
Practice Address - Country:US
Practice Address - Phone:845-838-4900
Practice Address - Fax:845-838-4915
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2023-03-07
Deactivation Date:2019-02-11
Deactivation Code:
Reactivation Date:2019-02-19
Provider Licenses
StateLicense IDTaxonomies
NY212602-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY212602-1OtherM.D. LICENSE
NY212602-1OtherM.D. LICENSE
G89613Medicare UPIN
NY69M011Medicare PIN