Provider Demographics
NPI:1386790251
Name:NASREEN KHAN
Entity type:Organization
Organization Name:NASREEN KHAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:MRS
Authorized Official - First Name:NASREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:212-868-0946
Mailing Address - Street 1:316 5TH AVE
Mailing Address - Street 2:ROOM 404
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-3602
Mailing Address - Country:US
Mailing Address - Phone:212-868-0946
Mailing Address - Fax:212-665-6895
Practice Address - Street 1:316 5TH AVE
Practice Address - Street 2:ROOM 404
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3602
Practice Address - Country:US
Practice Address - Phone:212-868-0946
Practice Address - Fax:212-665-6895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9214L001251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01210659Medicaid