Healthcare Provider Details

I. General information

NPI: 1447815071
Provider Name (Legal Business Name): GHULAM SAJJAD KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2019
Last Update Date: 01/16/2023
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 E RIDGEWOOD AVE
PARAMUS NJ
07652-4142
US

IV. Provider business mailing address

103 ELIZABETH AVE
ISELIN NJ
08830-2143
US

V. Phone/Fax

Practice location:
  • Phone: 862-588-0845
  • Fax:
Mailing address:
  • Phone: 862-588-0845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA11597000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: