Healthcare Provider Details

I. General information

NPI: 1669728556
Provider Name (Legal Business Name): IMRAN KHAN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2012
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
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: 302-853-7032
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 Number25MA11310800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: