Healthcare Provider Details

I. General information

NPI: 1316528177
Provider Name (Legal Business Name): ZARLAKHTA KHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11020 JAMAICA AVE
RICHMOND HILL NY
11418-2324
US

IV. Provider business mailing address

1000 MONTAUK HWY
WEST ISLIP NY
11795-4927
US

V. Phone/Fax

Practice location:
  • Phone: 718-850-4644
  • Fax: 845-765-9347
Mailing address:
  • Phone:
  • Fax: 631-376-3420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number329726
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: