Healthcare Provider Details

I. General information

NPI: 1558316299
Provider Name (Legal Business Name): AFTAB A KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 10/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MAGNOLIA AVENUE SUITE E
BRIDGETON NJ
08302
US

IV. Provider business mailing address

10 MAGNOLIA AVENUE SUITE E
BRIDGETON NJ
08302
US

V. Phone/Fax

Practice location:
  • Phone: 856-455-2399
  • Fax: 856-451-7791
Mailing address:
  • Phone: 856-455-2399
  • Fax: 856-451-7791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMA28568
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: