Healthcare Provider Details

I. General information

NPI: 1780471235
Provider Name (Legal Business Name): MUHAMMAD IMRAN KHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 04/21/2025
Certification Date: 04/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

857 S OYSTER BAY RD
BETHPAGE NY
11714-1030
US

IV. Provider business mailing address

1464 ASTOR AVE
BRONX NY
10469-5813
US

V. Phone/Fax

Practice location:
  • Phone: 516-622-8888
  • Fax:
Mailing address:
  • Phone: 516-286-9429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number356601
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: