Healthcare Provider Details

I. General information

NPI: 1750608899
Provider Name (Legal Business Name): TARIQ RAFIQ KHAN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 04/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 E 180TH ST
BRONX NY
10460-1305
US

IV. Provider business mailing address

15 WOODSTONE DR
VOORHEES NJ
08043-4735
US

V. Phone/Fax

Practice location:
  • Phone: 718-220-8300
  • Fax: 718-220-8330
Mailing address:
  • Phone: 856-745-3650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number182356
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: