=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821584194
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NY PHYSIATRY P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2018
-----------------------------------------------------
Last Update Date | 12/01/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 LYNDON PL
-----------------------------------------------------
City | MELVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11747-4255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-445-0495
-----------------------------------------------------
Fax | 540-300-9321
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 LYNDON PL
-----------------------------------------------------
City | MELVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11747-4255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-445-0495
-----------------------------------------------------
Fax | 540-300-9321
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. BILAL A KHAN
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 786-445-0495
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------