Provider Demographics
NPI:1154558419
Name:KHAN, RIZWANA (MD)
Entity type:Individual
Prefix:DR
First Name:RIZWANA
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2477 COUNTY RD 516 STE 103
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-4603
Mailing Address - Country:US
Mailing Address - Phone:732-952-2222
Mailing Address - Fax:732-952-8221
Practice Address - Street 1:2477 COUNTY RD 516 STE 103
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-4603
Practice Address - Country:US
Practice Address - Phone:732-952-2222
Practice Address - Fax:732-952-8221
Is Sole Proprietor?:No
Enumeration Date:2009-06-14
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08571500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ272900232OtherWESTSIDE MEDICAL ASSOCIATS, LLC