Healthcare Provider Details

I. General information

NPI: 1528400397
Provider Name (Legal Business Name): SAAD KHAN D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 TROY SCHENECTADY RD STE 101
LATHAM NY
12110-1074
US

IV. Provider business mailing address

200 S SERVICE RD STE 101
ROSLYN HEIGHTS NY
11577-2133
US

V. Phone/Fax

Practice location:
  • Phone: 518-348-3176
  • Fax:
Mailing address:
  • Phone: 516-340-0340
  • Fax: 858-769-1571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number265138
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberS3211
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number288055
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: