Provider Demographics
NPI:1619102662
Name:NASIR KHAN, MOHAMMAD USMAN (MBBS)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:USMAN
Last Name:NASIR KHAN
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 ROUTE 33
Mailing Address - Street 2:SUITE C 2ND FLOOR
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-3206
Mailing Address - Country:US
Mailing Address - Phone:732-212-6590
Mailing Address - Fax:732-922-2026
Practice Address - Street 1:3700 ROUTE 33
Practice Address - Street 2:SUITE C 2ND FLOOR
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-3206
Practice Address - Country:US
Practice Address - Phone:732-212-6590
Practice Address - Fax:732-922-2026
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD181872086S0129X
NJ25MA092243002086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME001363402Medicare PIN