Provider Demographics
NPI:1871694364
Name:KHAN, ISHRAT SULTANA (MD)
Entity type:Individual
Prefix:DR
First Name:ISHRAT
Middle Name:SULTANA
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14226 37TH AVE
Mailing Address - Street 2:FL 1
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4366
Mailing Address - Country:US
Mailing Address - Phone:718-886-8175
Mailing Address - Fax:
Practice Address - Street 1:13124 ROCKAWAY BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-2932
Practice Address - Country:US
Practice Address - Phone:718-659-7166
Practice Address - Fax:718-529-5930
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147087-1208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06723GMedicare ID - Type Unspecified
NYC11121Medicare UPIN