Provider Demographics
NPI:1912984063
Name:KHAN, AIJAZ (MD)
Entity Type:Individual
Prefix:DR
First Name:AIJAZ
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 1:187 DOT CT
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-5920
Mailing Address - Country:US
Mailing Address - Phone:516-764-3310
Mailing Address - Fax:516-766-0918
Practice Address - Street 1:187 DOT CT
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-5920
Practice Address - Country:US
Practice Address - Phone:516-764-3310
Practice Address - Fax:516-766-0918
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2049621207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01933646Medicaid
NY01933646Medicaid
NY9X2991Medicare ID - Type Unspecified