Provider Demographics
NPI:1669541264
Name:KHAN, SOHAILA (MD)
Entity type:Individual
Prefix:MRS
First Name:SOHAILA
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:SOHAILA
Other - Middle Name:
Other - Last Name:ANJUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 BURLEW PL
Mailing Address - Street 2:
Mailing Address - City:PARLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08859-1826
Mailing Address - Country:US
Mailing Address - Phone:732-316-5444
Mailing Address - Fax:732-316-0001
Practice Address - Street 1:11 BURLEW PL
Practice Address - Street 2:
Practice Address - City:PARLIN
Practice Address - State:NJ
Practice Address - Zip Code:08859-1826
Practice Address - Country:US
Practice Address - Phone:732-316-5444
Practice Address - Fax:732-316-0001
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA70922208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8450404Medicaid