Healthcare Provider Details

I. General information

NPI: 1649272022
Provider Name (Legal Business Name): AMJAD KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 COLUMBUS CIR STE A
EDISON NJ
08837-3907
US

IV. Provider business mailing address

300 COLUMBUS CIR STE A
EDISON NJ
08837-3907
US

V. Phone/Fax

Practice location:
  • Phone: 866-909-7284
  • Fax: 908-272-1478
Mailing address:
  • Phone: 866-909-7284
  • Fax: 908-272-1478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License NumberMA060940
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMA060940
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier6470602
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer
# 2
Identifier016600500
Identifier TypeMEDICAID
Identifier StateFL
Identifier IssuerFlorida Medicaid Provider ID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: