Provider Demographics
NPI:1750608899
Name:KHAN, TARIQ RAFIQ (MD)
Entity type:Individual
Prefix:DR
First Name:TARIQ
Middle Name:RAFIQ
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 1:15 WOODSTONE DR
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4735
Mailing Address - Country:US
Mailing Address - Phone:856-745-3650
Mailing Address - Fax:
Practice Address - Street 1:817 E 180TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-1305
Practice Address - Country:US
Practice Address - Phone:718-220-8300
Practice Address - Fax:718-220-8330
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182356208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics