Provider Demographics
NPI:1760269781
Name:KHAN, SAQIB ISHAQ
Entity Type:Individual
Prefix:
First Name:SAQIB
Middle Name:ISHAQ
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 1:58 RICHARD TER
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-6242
Mailing Address - Country:US
Mailing Address - Phone:908-324-8779
Mailing Address - Fax:
Practice Address - Street 1:58 RICHARD TER
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-6242
Practice Address - Country:US
Practice Address - Phone:908-324-8779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJK31756916910912172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver