Provider Demographics
NPI:1598328411
Name:NISHTAR ON POTOMAC MEDICAL & REHABILITATION CENTERS LLC
Entity Type:Organization
Organization Name:NISHTAR ON POTOMAC MEDICAL & REHABILITATION CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ZAFAR
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DRNP, MS, MBBS
Authorized Official - Phone:703-780-3593
Mailing Address - Street 1:2734 MANORHAVEN CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3158
Mailing Address - Country:US
Mailing Address - Phone:703-780-3593
Mailing Address - Fax:
Practice Address - Street 1:7115 LEESBURG PIKE STE 315
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22043-2301
Practice Address - Country:US
Practice Address - Phone:703-522-8840
Practice Address - Fax:703-496-7238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
1174876775OtherINDIVIDUAL NPI FOR DR. ZAFAR ALI KHAN