Provider Demographics
NPI:1538257324
Name:KHAN, JAWED AKBER (PT)
Entity type:Individual
Prefix:MR
First Name:JAWED
Middle Name:AKBER
Last Name:KHAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 LEAHY ST
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-1618
Mailing Address - Country:US
Mailing Address - Phone:516-433-5288
Mailing Address - Fax:516-822-3418
Practice Address - Street 1:100 NEWBRIDGE RD
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-3963
Practice Address - Country:US
Practice Address - Phone:516-822-9400
Practice Address - Fax:516-822-3418
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011193225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY011193OtherLICENSE
NY01977691Medicaid
NY01977691Medicaid