Provider Demographics
NPI:1891740429
Name:KHAN, KHURRAM (PT)
Entity Type:Individual
Prefix:
First Name:KHURRAM
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 30TH AVE
Mailing Address - Street 2:SUITE C1
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-4189
Mailing Address - Country:US
Mailing Address - Phone:917-685-5954
Mailing Address - Fax:718-425-8975
Practice Address - Street 1:2124 30TH AVE
Practice Address - Street 2:SUITE C1
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-4189
Practice Address - Country:US
Practice Address - Phone:917-685-5954
Practice Address - Fax:718-425-8975
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0259752251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6607395OtherGHI PPO