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General NPI Number Information
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NPI Number | 1871694364
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Entity Type | Individual
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Provider Name | ISHRAT SULTANA KHAN MD
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Gender | Female
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 03/13/2019
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Provider Practice Location Address
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Address Line | 13124 ROCKAWAY BLVD
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City | SOUTH OZONE PARK
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State | NY
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Zip | 11420-2932
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Country | US
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Telephone | 718-659-7166
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Fax | 718-529-5930
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Provider Business Mailing Address
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Address Line | 14226 37TH AVE FL 1
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City | FLUSHING
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State | NY
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Zip | 11354-4366
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Country | US
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Telephone | 718-886-8175
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 147087-1
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License Number State | NY
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