Provider Demographics
NPI:1851480917
Name:KHAN, TAJ G (DO)
Entity Type:Individual
Prefix:
First Name:TAJ
Middle Name:G
Last Name:KHAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1530 SAINT GEORGES AVE
Mailing Address - Street 2:
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065-2750
Mailing Address - Country:US
Mailing Address - Phone:732-382-7473
Mailing Address - Fax:732-382-9045
Practice Address - Street 1:1530 SAINT GEORGES AVE
Practice Address - Street 2:
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065-2750
Practice Address - Country:US
Practice Address - Phone:732-382-7473
Practice Address - Fax:732-382-9045
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB07079100207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ180044407OtherRAILROAD MEDICARE
NJ408B61OtherWELLCHOICE/ EMPIRE BC/BS
NJP2548881OtherOXFORD
NJ0498963OtherGHI
NJ5001815OtherCIGNA
NJ2120045OtherUNITED HEALTHCARE
NJ7536280OtherAETNA
NJH19765Medicare UPIN
NJ5001815OtherCIGNA