Provider Demographics
NPI:1477605715
Name:MULAZIM H.KHAN GENERAL SURGERY P.C.
Entity Type:Organization
Organization Name:MULAZIM H.KHAN GENERAL SURGERY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MULAZIM
Authorized Official - Middle Name:HUSSAIN
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-493-0110
Mailing Address - Street 1:3 BRIDGE ST
Mailing Address - Street 2:SUIT 4
Mailing Address - City:CARTHAGE
Mailing Address - State:NY
Mailing Address - Zip Code:13619-1333
Mailing Address - Country:US
Mailing Address - Phone:315-493-0110
Mailing Address - Fax:315-493-1136
Practice Address - Street 1:3 BRIDGE ST
Practice Address - Street 2:SUIT 4
Practice Address - City:CARTHAGE
Practice Address - State:NY
Practice Address - Zip Code:13619-1333
Practice Address - Country:US
Practice Address - Phone:315-493-0110
Practice Address - Fax:315-493-1136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113496208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMD-00469347Medicaid
NY=========OtherALL OTHER INSURENCES
NY=========OtherALL OTHER INSURENCES