Provider Demographics
NPI:1386975324
Name:KHAN, SHAMEEN (DO)
Entity type:Individual
Prefix:
First Name:SHAMEEN
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 SCHANCK RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-3068
Mailing Address - Country:US
Mailing Address - Phone:732-431-8266
Mailing Address - Fax:732-294-9794
Practice Address - Street 1:222 SCHANCK RD
Practice Address - Street 2:SUITE 203
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-3068
Practice Address - Country:US
Practice Address - Phone:732-431-8266
Practice Address - Fax:732-294-9794
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08560800207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1386975324OtherQUALCARE PPO/HMO
NJ1386975324OtherTRICARE HEALTHNET
NJ9419561OtherAETNA PPO
NJ7688987OtherCIGNA, GREATWEST
NJ1386975324OtherCHAMPVA
NJ392723OtherU.S. FAMILY HEALTH
NJ1386975324OtherCOVENTRY HEALTH-FIRST HEALTH
NJ211545OtherCHN
NJ5153120OtherAETNA HMO
NJ1386975324OtherMULTIPLAN PHCS
NJ3813587000OtherAMERIHEALTH
NJ9419561OtherAETNA PPO