Healthcare Provider Details

I. General information

NPI: 1013975234
Provider Name (Legal Business Name): FAIZ A KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 LONG DRIVE CT
DIX HILLS NY
11746-5826
US

IV. Provider business mailing address

NASSAU UNIVERSITY MED. CTR. 2201 HEMPSTEAD TPK MEDICAL STAFF OFFICE BOX 42
EAST MEADOW NY
11554-0854
US

V. Phone/Fax

Practice location:
  • Phone: 516-426-9086
  • Fax:
Mailing address:
  • Phone: 516-572-6175
  • Fax: 516-572-5465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number211517
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number211517
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: