Provider Demographics
NPI:1104130947
Name:KHAN, REHAN E (DNP-BC)
Entity type:Individual
Prefix:
First Name:REHAN
Middle Name:E
Last Name:KHAN
Suffix:
Gender:M
Credentials:DNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 W 114TH ST
Mailing Address - Street 2:APT. 73
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-7972
Mailing Address - Country:US
Mailing Address - Phone:917-597-3533
Mailing Address - Fax:212-665-6895
Practice Address - Street 1:609 W 114TH ST
Practice Address - Street 2:APT. 73
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025
Practice Address - Country:US
Practice Address - Phone:917-597-3533
Practice Address - Fax:212-665-6895
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY632777163W00000X
NY343149363LF0000X, 204C00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine