Healthcare Provider Details

I. General information

NPI: 1497246391
Provider Name (Legal Business Name): DANYAL FAROOQ KHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2018
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 RIDGEDALE AVE
CEDAR KNOLLS NJ
07927-1313
US

IV. Provider business mailing address

65 RIDGEDALE AVE
CEDAR KNOLLS NJ
07927-1313
US

V. Phone/Fax

Practice location:
  • Phone: 973-401-1100
  • Fax:
Mailing address:
  • Phone: 973-401-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number25MA13005200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: