MEDICARE: MOHAMMED Q KHAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	192956	NY

General Provider Information

NPI Number	:	1710950662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMMED Q KHAN

Provider Business Mailing Address
First Line	:	2094 PITKIN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11207-3509
Country	:	US
Telephone Number	:	718-240-0420
Fax Number	:	718-240-0564

Provider Business Practice Location Address
First Line	:	2094 PITKIN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11207-3509
Country	:	US
Telephone Number	:	718-240-0420
Fax Number	:	718-240-0564

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	09/17/2010

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Directions to “ MOHAMMED Q KHAN ” Practice Location

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