Provider Demographics
NPI:1508958471
Name:KHAN, AMBER MANZOOR (MD)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:MANZOOR
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 1:1500 MOUNTAIN TOP RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-1837
Mailing Address - Country:US
Mailing Address - Phone:908-522-1313
Mailing Address - Fax:908-522-1302
Practice Address - Street 1:1500 MOUNTAIN TOP RD
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-1837
Practice Address - Country:US
Practice Address - Phone:908-522-1313
Practice Address - Fax:908-522-1302
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07209000207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ20-1466845OtherTAX ID
NJ083446Medicare ID - Type Unspecified
NJ20-1466845OtherTAX ID