Provider Demographics
NPI:1740251511
Name:KHAN, FEROZE B (MD)
Entity type:Individual
Prefix:
First Name:FEROZE
Middle Name:B
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11 RALPH PL
Mailing Address - Street 2:SUITE#210
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-4419
Mailing Address - Country:US
Mailing Address - Phone:718-816-1482
Mailing Address - Fax:718-815-0386
Practice Address - Street 1:11 RALPH PL
Practice Address - Street 2:SUITE#210
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-4419
Practice Address - Country:US
Practice Address - Phone:718-816-1482
Practice Address - Fax:718-815-0386
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2012-07-18
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Provider Licenses
StateLicense IDTaxonomies
NY128610208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY020010615OtherRR MEDICARE
NY00724949Medicaid
NY00724949Medicaid
B79249Medicare UPIN