Healthcare Provider Details

I. General information

NPI: 1376840561
Provider Name (Legal Business Name): IMTIAZ AFZAL KHAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2011
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 UNION SQ E STE 4K
NEW YORK NY
10003-3314
US

IV. Provider business mailing address

10 UNION SQ E STE 4K
NEW YORK NY
10003-3314
US

V. Phone/Fax

Practice location:
  • Phone: 212-844-8241
  • Fax:
Mailing address:
  • Phone: 212-844-8241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0072941
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: