Healthcare Provider Details

I. General information

NPI: 1982930640
Provider Name (Legal Business Name): ASMA KHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2009
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 STONEWALL CIR
WEST HARRISON NY
10604-1146
US

IV. Provider business mailing address

98 STONEWALL CIRCLE
WEST HARRISON NY
10604-4006
US

V. Phone/Fax

Practice location:
  • Phone: 216-903-5785
  • Fax:
Mailing address:
  • Phone: 216-903-5785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number261833
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: