Healthcare Provider Details

I. General information

NPI: 1225293384
Provider Name (Legal Business Name): HAROON M KHAN P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2008
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 STATE ROUTE 33 SUITE 4B
NEPTUNE NJ
07753-4860
US

IV. Provider business mailing address

1820 STATE ROUTE 33 SUITE 4B
NEPTUNE NJ
07753-4860
US

V. Phone/Fax

Practice location:
  • Phone: 732-776-8500
  • Fax: 732-776-8946
Mailing address:
  • Phone: 732-776-8500
  • Fax: 732-776-8946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00201500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: