Provider Demographics
NPI:1194875260
Name:KHAN, BASMA (MD)
Entity type:Individual
Prefix:DR
First Name:BASMA
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 1:21 HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1632
Mailing Address - Country:US
Mailing Address - Phone:732-986-0641
Mailing Address - Fax:
Practice Address - Street 1:AZZ MEDICAL ASSOCIATES 200 PERRINE RD
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2842
Practice Address - Country:US
Practice Address - Phone:609-890-1050
Practice Address - Fax:609-890-0950
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07982900208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ096793UVFMedicare ID - Type Unspecified
NJI47799Medicare UPIN