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General NPI Number Information
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NPI Number | 1679250633
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Entity Type | Individual
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Provider Name | TASFIA ANJUM KHAN
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Gender | Female
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Dates
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Enumeration Date | 06/30/2023
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Last Update Date | 06/30/2023
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Provider Practice Location Address
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Address Line | 425 BEACH AVE
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City | ROCHESTER
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State | NY
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Zip | 14612-2011
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Country | US
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Telephone | 917-686-6162
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Fax |
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Provider Business Mailing Address
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Address Line | 10469 NW 289TH AVE
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City | NORTH PLAINS
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State | OR
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Zip | 97133-2044
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Country | US
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Telephone | 469-386-8270
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | P122560
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License Number State | NY
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