Healthcare Provider Details

I. General information

NPI: 1518594068
Provider Name (Legal Business Name): NIDA KHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

896 OLD COUNTRY RD STE 200
RIVERHEAD NY
11901-2154
US

IV. Provider business mailing address

45 ARBOR FIELD WAY
LAKE GROVE NY
11755-1833
US

V. Phone/Fax

Practice location:
  • Phone: 631-846-5250
  • Fax:
Mailing address:
  • Phone: 631-804-7330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number336541
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number336541
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: