Healthcare Provider Details

I. General information

NPI: 1992065593
Provider Name (Legal Business Name): SUNNIYA KHAN M.B, B.S, M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUNNIYA KHAN M.D

II. Dates (important events)

Enumeration Date: 05/17/2012
Last Update Date: 12/24/2024
Certification Date: 12/24/2024
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

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number25MA09866300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0099469
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: