Provider Demographics
NPI:1104994649
Name:DEWAN S KHAN M.D. PC
Entity type:Organization
Organization Name:DEWAN S KHAN M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEWAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-697-1919
Mailing Address - Street 1:PO BOX 7438
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816
Mailing Address - Country:US
Mailing Address - Phone:732-697-1919
Mailing Address - Fax:800-954-0789
Practice Address - Street 1:146 NEW BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:HOPETOWN
Practice Address - State:NJ
Practice Address - Zip Code:08861
Practice Address - Country:US
Practice Address - Phone:732-697-1919
Practice Address - Fax:800-954-0789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA61758207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7067801Medicaid
NJ788299Medicare ID - Type UnspecifiedMDCR#
NJG10395Medicare UPIN