Healthcare Provider Details

I. General information

NPI: 1275976045
Provider Name (Legal Business Name): NAZIM A. KHAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2013
Last Update Date: 12/18/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 GRANT ST
BUFFALO NY
14213-1604
US

IV. Provider business mailing address

4979 HARLEM RD
AMHERST NY
14226-2547
US

V. Phone/Fax

Practice location:
  • Phone: 716-881-4300
  • Fax: 716-881-5300
Mailing address:
  • Phone: 716-923-4380
  • Fax: 716-923-4384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number022068
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: