Healthcare Provider Details

I. General information

NPI: 1205771987
Provider Name (Legal Business Name): QAISAR ALI KHAN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 JAMES STREET,
EDISON NJ
08820
US

IV. Provider business mailing address

65 JAMES STREET,
EDISON NJ
08820
US

V. Phone/Fax

Practice location:
  • Phone: 732-744-5119
  • Fax: 732-744-5782
Mailing address:
  • Phone: 732-744-5119
  • Fax: 732-744-5782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: