Healthcare Provider Details

I. General information

NPI: 1629198775
Provider Name (Legal Business Name): AFSHAN KHAN PHYSICIAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 09/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1654 MAYFLOWER AVE
BRONX NY
10461-4818
US

IV. Provider business mailing address

1654 MAYFLOWER AVE
BRONX NY
10461-4818
US

V. Phone/Fax

Practice location:
  • Phone: 718-823-7180
  • Fax: 718-823-0839
Mailing address:
  • Phone: 718-823-7180
  • Fax: 718-823-0839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number198462
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number198462
License Number StateNY

VIII. Authorized Official

Name: AFSHAN MURAD KHAN
Title or Position: PRESIDENT
Credential: M.D
Phone: 718-823-7180