Provider Demographics
NPI:1669728556
Name:KHAN, IMRAN (MD)
Entity type:Individual
Prefix:
First Name:IMRAN
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 ROUTE 202/206 STE 105
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-1758
Mailing Address - Country:US
Mailing Address - Phone:302-853-7032
Mailing Address - Fax:908-548-9201
Practice Address - Street 1:745 ROUTE 202/206 STE 105
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-1758
Practice Address - Country:US
Practice Address - Phone:302-853-7032
Practice Address - Fax:302-853-7032
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA113108002084N0400X
MT608242084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology