Provider Demographics
NPI:1629168919
Name:KHAN, ANWAR AHMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:ANWAR
Middle Name:AHMAD
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 YORK ST
Mailing Address - Street 2:SUITE # 101
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-3838
Mailing Address - Country:US
Mailing Address - Phone:201-626-7201
Mailing Address - Fax:201-526-7202
Practice Address - Street 1:66 YORK ST
Practice Address - Street 2:SUITE # 101
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-3838
Practice Address - Country:US
Practice Address - Phone:201-626-7201
Practice Address - Fax:201-526-7202
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-15
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226439146D00000X
NY226439-01207P00000X
TXN9240207P00000X
NJ25MA07606700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0123382Medicaid
NJ090618TLMMedicare PIN
P00404157Medicare PIN