Provider Demographics
NPI:1619613684
Name:KHAN, MUHAMMAD JAHANZAIB
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:JAHANZAIB
Last Name:KHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 NORTH COUNTRY ROAD, APT C10
Mailing Address - Street 2:APT C10
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777
Mailing Address - Country:US
Mailing Address - Phone:631-202-9755
Mailing Address - Fax:631-686-7651
Practice Address - Street 1:75 NORTH COUNTRY ROAD, MATHER HOSPITAL
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777
Practice Address - Country:US
Practice Address - Phone:631-686-2549
Practice Address - Fax:631-686-7651
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2023-12-19
Deactivation Date:2022-12-27
Deactivation Code:
Reactivation Date:2023-12-19
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program