Healthcare Provider Details

I. General information

NPI: 1477282010
Provider Name (Legal Business Name): PATH CLINICAL SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 AUER CT STE 102
EAST BRUNSWICK NJ
08816-5848
US

IV. Provider business mailing address

255 REGIS DR
STATEN ISLAND NY
10314-1428
US

V. Phone/Fax

Practice location:
  • Phone: 917-683-2304
  • Fax:
Mailing address:
  • Phone: 908-248-5672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SUNNIYA KHAN
Title or Position: PHYSICIAN
Credential: MD
Phone: 908-248-5672