Provider Demographics
NPI:1396258737
Name:KHAN, TANZINA MOSLEMIN
Entity type:Individual
Prefix:
First Name:TANZINA
Middle Name:MOSLEMIN
Last Name:KHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22519 88TH AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11427-2614
Mailing Address - Country:US
Mailing Address - Phone:646-667-1941
Mailing Address - Fax:
Practice Address - Street 1:22519 88TH AVE FL 2
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-2614
Practice Address - Country:US
Practice Address - Phone:646-667-1941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3510400174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3510400OtherTEACHER ID