MEDICARE: DR. JIBRAN ALI KHAN DO

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	207X00000X	Orthopaedic Surgery Physician	198907	OR

General Provider Information

NPI Number	:	1932737640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JIBRAN ALI KHAN DO

Provider Business Mailing Address
First Line	:	355 GRAND ST
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-4321
Country	:	US
Telephone Number	:	201-915-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	504 VALLEY RD STE 203
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-3534
Country	:	US
Telephone Number	:	973-686-0700
Fax Number	:

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

Provider Enumeration Date	:	03/29/2020
Last Update Date	:	02/08/2026

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