Healthcare Provider Details

I. General information

NPI: 1093891947
Provider Name (Legal Business Name): UNAB I KHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHAM 3415 BAINBRIDGE AVENUE
BRONX NY
10467
US

IV. Provider business mailing address

111 E 210TH ST DIVISION OF ADOLESCENT MEDICINE
BRONX NY
10467-2401
US

V. Phone/Fax

Practice location:
  • Phone: 718-741-2450
  • Fax:
Mailing address:
  • Phone: 718-920-6781
  • Fax: 718-944-5862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number228911
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: