Healthcare Provider Details

I. General information

NPI: 1780695528
Provider Name (Legal Business Name): ZAHIDA KHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 IRVING AVE RIDGEWOOD MEDICAL AND DENTAL
BROOKLYN NY
11237-8024
US

IV. Provider business mailing address

155 WENTWORTH AVE
ALBERTSON NY
11507
US

V. Phone/Fax

Practice location:
  • Phone: 718-386-3062
  • Fax: 718-386-2402
Mailing address:
  • Phone: 718-386-3062
  • Fax: 516-294-4558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1482741
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: