MEDICARE: MAXINE KHAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	030428	NY

General Provider Information

NPI Number	:	1366747958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAXINE KHAN

Provider Business Mailing Address
First Line	:	65 COURT ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-4916
Country	:	US
Telephone Number	:	347-433-5033
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 LIVINGSTON ST
Second Line	:	SUITE 1101
City	:	BROOKLYN
State	:	NY
Zip	:	11201-1260
Country	:	US
Telephone Number	:	646-662-2562
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2011
Last Update Date	:	02/08/2023

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