1386975324 NPI number — SHAMEEN KHAN D.O.

Table of content: SHAMEEN KHAN D.O. (NPI 1386975324)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386975324 NPI number — SHAMEEN KHAN D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KHAN
Provider First Name:
SHAMEEN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386975324
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/23/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
222 SCHANCK RD
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
FREEHOLD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07728-3068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-431-8266
Provider Business Mailing Address Fax Number:
732-294-9794

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 SCHANCK RD
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
FREEHOLD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07728-3068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-431-8266
Provider Business Practice Location Address Fax Number:
732-294-9794
Provider Enumeration Date:
01/14/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , with the licence number:  25MB08560800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1386975324 . This is a "QUALCARE PPO/HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1386975324 . This is a "TRICARE HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 9419561 . This is a "AETNA PPO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7688987 . This is a "CIGNA, GREATWEST" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1386975324 . This is a "CHAMPVA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 392723 . This is a "U.S. FAMILY HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1386975324 . This is a "COVENTRY HEALTH-FIRST HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 211545 . This is a "CHN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 5153120 . This is a "AETNA HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1386975324 . This is a "MULTIPLAN PHCS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3813587000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".