Healthcare Provider Details

I. General information

NPI: 1407070667
Provider Name (Legal Business Name): FATIMA M KHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26701 HILLSIDE AVE
FLORAL PARK NY
11004-1743
US

IV. Provider business mailing address

26701 HILLSIDE AVE
FLORAL PARK NY
11004-1743
US

V. Phone/Fax

Practice location:
  • Phone: 718-343-7790
  • Fax: 718-343-7792
Mailing address:
  • Phone: 718-343-7790
  • Fax: 718-343-7792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberE-5465
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number268169
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: