Healthcare Provider Details

I. General information

NPI: 1467995399
Provider Name (Legal Business Name): ASIM NISAR KHAN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2016
Last Update Date: 12/15/2023
Certification Date: 12/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 HILLCREST AVE
MONTVALE NJ
07645-2228
US

IV. Provider business mailing address

POBOX 10437
DHAHRAN EASTERN
31311
SA

V. Phone/Fax

Practice location:
  • Phone: 630-300-3762
  • Fax:
Mailing address:
  • Phone: 011966508285482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036150347
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number206425
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: