Provider Demographics
NPI:1790885556
Name:KHAN, RUBINA FEROZ
Entity Type:Individual
Prefix:
First Name:RUBINA
Middle Name:FEROZ
Last Name:KHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 E 13TH ST
Mailing Address - Street 2:APT 7
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-5607
Mailing Address - Country:US
Mailing Address - Phone:917-309-2734
Mailing Address - Fax:
Practice Address - Street 1:330 EAST 17TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-420-2850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008046363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02272975Medicaid
NY02272975Medicaid
P00410887Medicare PIN
NY0421AFMedicare PIN