Provider Demographics
NPI:1467995399
Name:KHAN, ASIM NISAR (MD)
Entity Type:Individual
Prefix:
First Name:ASIM
Middle Name:NISAR
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:POBOX 10437
Mailing Address - Street 2:
Mailing Address - City:DHAHRAN
Mailing Address - State:EASTERN
Mailing Address - Zip Code:31311
Mailing Address - Country:SA
Mailing Address - Phone:01196650-828-5482
Mailing Address - Fax:
Practice Address - Street 1:2 HILLCREST AVE
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-2228
Practice Address - Country:US
Practice Address - Phone:630-300-3762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-26
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206425207LP2900X
IL036150347207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine