Provider Demographics
NPI:1942337480
Name:ALTAF A KHAN
Entity Type:Organization
Organization Name:ALTAF A KHAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:ALTAF
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-443-0478
Mailing Address - Street 1:610 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-1509
Mailing Address - Country:US
Mailing Address - Phone:718-443-0478
Mailing Address - Fax:718-443-0478
Practice Address - Street 1:610 WILSON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-1509
Practice Address - Country:US
Practice Address - Phone:718-443-0478
Practice Address - Fax:718-443-0478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00218240Medicaid
NY642291Medicare ID - Type Unspecified
NYB78562Medicare UPIN