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General NPI Number Information
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NPI Number | 1659791663
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Entity Type | Individual
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Provider Name | MOHAMMAD IBRAHEEM KHAN MD
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Gender | Male
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Dates
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Enumeration Date | 04/17/2014
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Last Update Date | 07/01/2020
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Provider Practice Location Address
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Address Line | STONY BROOK UFPC PRACTICE 101 NICOLLS ROAD HSC T17-060
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City | STONY BROOK
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State | NY
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Zip | 11794-6999
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Country | US
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Telephone | 631-444-3518
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Fax | 631-444-8886
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Provider Business Mailing Address
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Address Line | PO BOX 1559
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City | STONY BROOK
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State | NY
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Zip | 11790-0989
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Country | US
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Telephone | 631-444-3518
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Fax | 631-444-8886
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 305306
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License Number State | NY
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