Provider Demographics
NPI:1871175687
Name:KHAN, MAHRUKH ALI (MD)
Entity type:Individual
Prefix:
First Name:MAHRUKH
Middle Name:ALI
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7280 LAKE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:AVA
Mailing Address - State:NY
Mailing Address - Zip Code:13303-1807
Mailing Address - Country:US
Mailing Address - Phone:315-335-6447
Mailing Address - Fax:
Practice Address - Street 1:300 SECOND AVENUE
Practice Address - Street 2:
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-6303
Practice Address - Country:US
Practice Address - Phone:315-335-6447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program