Provider Demographics
NPI:1386887206
Name:KHAN, KHURRAM HAYAT (LPN)
Entity type:Individual
Prefix:
First Name:KHURRAM
Middle Name:HAYAT
Last Name:KHAN
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 TAMMY DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-2052
Mailing Address - Country:US
Mailing Address - Phone:845-239-9637
Mailing Address - Fax:
Practice Address - Street 1:16 TAMMY DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-2052
Practice Address - Country:US
Practice Address - Phone:845-673-5174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251558164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse