Healthcare Provider Details

I. General information

NPI: 1376535252
Provider Name (Legal Business Name): TABASSUM YASMIN KHAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date: 02/11/2019
Reactivation Date: 02/19/2019

III. Provider practice location address

223 MAIN ST
BEACON NY
12508-2770
US

IV. Provider business mailing address

230 NORTH RD
POUGHKEEPSIE NY
12601-1328
US

V. Phone/Fax

Practice location:
  • Phone: 845-838-4900
  • Fax: 845-838-4915
Mailing address:
  • Phone: 845-486-2703
  • Fax: 845-471-3406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number212602-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: