Healthcare Provider Details

I. General information

NPI: 1669396412
Provider Name (Legal Business Name): AASIYA KHAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 CLYDE RD STE 102
SOMERSET NJ
08873-5039
US

IV. Provider business mailing address

27 CLYDE RD STE 102
SOMERSET NJ
08873-5039
US

V. Phone/Fax

Practice location:
  • Phone: 848-205-6649
  • Fax:
Mailing address:
  • Phone: 848-205-6649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP01041300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: