Healthcare Provider Details

I. General information

NPI: 1912969478
Provider Name (Legal Business Name): NAFIS KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 M ST AND MADISON AVE
NEW YORK NY
10029
US

IV. Provider business mailing address

PO BOX 1149 ONE GUSTAVE LEVY PLACE
NEW YORK NY
10029
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-0101
  • Fax: 212-426-5083
Mailing address:
  • Phone: 212-241-0101
  • Fax: 212-426-5083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number1930271
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: