Healthcare Provider Details

I. General information

NPI: 1528893229
Provider Name (Legal Business Name): INFINITEAXON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 ROUTE 202/206 STE 105
BRIDGEWATER NJ
08807-1758
US

IV. Provider business mailing address

745 ROUTE 202/206 STE 105
BRIDGEWATER NJ
08807-1758
US

V. Phone/Fax

Practice location:
  • Phone: 302-853-7032
  • Fax: 908-548-9201
Mailing address:
  • Phone: 302-853-7032
  • Fax: 908-548-9201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. IMRAN KHAN
Title or Position: NEUROLOGIST/CEO
Credential: M.D
Phone: 302-853-7032