Provider Demographics
NPI:1962594812
Name:KHAN, NAZMUL HOSSAIN (MD)
Entity type:Individual
Prefix:DR
First Name:NAZMUL
Middle Name:HOSSAIN
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87-30 167TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-3636
Mailing Address - Country:US
Mailing Address - Phone:718-262-8991
Mailing Address - Fax:718-262-8992
Practice Address - Street 1:8730 167TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3636
Practice Address - Country:US
Practice Address - Phone:718-262-8991
Practice Address - Fax:718-262-8992
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY192779207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246075Medicaid
NY00330231Medicare ID - Type Unspecified
NY00246075Medicaid