Provider Demographics
NPI:1740641935
Name:WASIM KHAN MD MPH CORPORATION
Entity type:Organization
Organization Name:WASIM KHAN MD MPH CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WASIM
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-812-0514
Mailing Address - Street 1:19 JILLIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-3443
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19 JILLIAN BLVD
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-3443
Practice Address - Country:US
Practice Address - Phone:973-585-7052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744R1102XOther Service ProvidersSpecialistResearch StudyGroup - Single Specialty
No171W00000XOther Service ProvidersContractorGroup - Single Specialty
No1744R1103XOther Service ProvidersSpecialistResearch Data Abstracter/CoderGroup - Single Specialty
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearchGroup - Single Specialty