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General NPI Number Information
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NPI Number | 1669490694
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Entity Type | Organization
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Legal Business Name | MIRZA M ASHRAF & MULAZIM H KHAN
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 03/17/2015
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Provider Practice Location Address
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Address Line | 32787 US RT 11
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City | PHILADELPHIA
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State | NY
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Zip | 13673
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Country | US
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Telephone | 315-642-0026
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Fax | 315-642-1028
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Provider Business Mailing Address
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Address Line | PO BOX 479
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City | PHILADELPHIA
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State | NY
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Zip | 13673
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Country | US
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Telephone | 315-642-0026
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Fax | 314-642-1028
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Authorized Official
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Title or Position | MANAGER
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Name | MS. CATHERINE M MURPHY
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Credential | CPC
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Telephone | 315-493-1450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 003616-1
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License Number State | NY
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