Healthcare Provider Details

I. General information

NPI: 1033186002
Provider Name (Legal Business Name): SAJID ALI KHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 08/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 FRONT ST SUITE C
VESTAL NY
13850-1559
US

IV. Provider business mailing address

46 HARRISON ST
JOHNSON CITY NY
13790-2120
US

V. Phone/Fax

Practice location:
  • Phone: 607-748-7468
  • Fax: 607-748-7469
Mailing address:
  • Phone: 607-729-4942
  • Fax: 607-729-7516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberD0064244
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberD0064244
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: