Healthcare Provider Details

I. General information

NPI: 1295761294
Provider Name (Legal Business Name): YASMEEN KHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 02/18/2024
Certification Date: 02/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 ELMORA AVE
ELIZABETH NJ
07202-1169
US

IV. Provider business mailing address

PO BOX 656
SADDLE RIVER NJ
07458-0656
US

V. Phone/Fax

Practice location:
  • Phone: 201-560-7611
  • Fax:
Mailing address:
  • Phone: 201-560-7611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA08381900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: