Healthcare Provider Details

I. General information

NPI: 1023709961
Provider Name (Legal Business Name): ALIA ALMAS KHAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2023
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 E MAIN ST
ENDICOTT NY
13760-4925
US

IV. Provider business mailing address

413 E MAIN ST
ENDICOTT NY
13760-4925
US

V. Phone/Fax

Practice location:
  • Phone: 607-785-2460
  • Fax:
Mailing address:
  • Phone: 607-785-2460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number345253
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: