Provider Demographics
NPI:1710491592
Name:A KHAN PHYSICIAN PC
Entity Type:Organization
Organization Name:A KHAN PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:VALVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-764-3310
Mailing Address - Street 1:187 DOT CT E
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-5920
Mailing Address - Country:US
Mailing Address - Phone:516-404-1660
Mailing Address - Fax:
Practice Address - Street 1:187 DOT CT E
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-5920
Practice Address - Country:US
Practice Address - Phone:516-404-1660
Practice Address - Fax:516-404-1660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care