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General NPI Number Information
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NPI Number | 1811708688
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Entity Type | Individual
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Provider Name | MARIAM SALEEM KHAN PA
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Gender | Female
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Dates
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Enumeration Date | 01/20/2025
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Last Update Date | 01/20/2025
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Provider Practice Location Address
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Address Line | 67 E RIDGEWOOD AVE
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City | PARAMUS
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State | NJ
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Zip | 07652-3623
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Country | US
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Telephone | 201-262-2010
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Fax |
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Provider Business Mailing Address
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Address Line | 11 CORNWALL DR
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City | EAST WINDSOR
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State | NJ
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Zip | 08520-1107
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Country | US
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Telephone | 201-887-0543
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 25MP00907700
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License Number State | NJ
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