Provider Demographics
NPI:1578958088
Name:KHAN, SAIRA
Entity Type:Individual
Prefix:
First Name:SAIRA
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SAIRA
Other - Middle Name:
Other - Last Name:KHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2066 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3960
Mailing Address - Country:US
Mailing Address - Phone:718-982-9001
Mailing Address - Fax:718-982-9008
Practice Address - Street 1:2066 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314
Practice Address - Country:US
Practice Address - Phone:718-982-9001
Practice Address - Fax:718-982-9008
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10276600208000000X
NY285624-1208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics