Provider Demographics
NPI:1336570159
Name:KHAN, JOEMELLE (LPN)
Entity Type:Individual
Prefix:MR
First Name:JOEMELLE
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14403 WELLER LN
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-2533
Mailing Address - Country:US
Mailing Address - Phone:347-751-3099
Mailing Address - Fax:
Practice Address - Street 1:14403 WELLER LN
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-2533
Practice Address - Country:US
Practice Address - Phone:347-751-3099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-04
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3171281164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse