Healthcare Provider Details

I. General information

NPI: 1649763343
Provider Name (Legal Business Name): RIZWAN KHAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HAMILTON HEALTH PL
HAMILTON NJ
08690-3542
US

IV. Provider business mailing address

245 N 15TH ST FL 6 MS 427
PHILADELPHIA PA
19102-1101
US

V. Phone/Fax

Practice location:
  • Phone: 609-586-7900
  • Fax:
Mailing address:
  • Phone: 215-762-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MB11453300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: