1194037457 NPI number — MRS. JAMEELA YASMEEN KHAN RPA-C

Table of content: MRS. JAMEELA YASMEEN KHAN RPA-C (NPI 1194037457)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194037457 NPI number — MRS. JAMEELA YASMEEN KHAN RPA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KHAN
Provider First Name:
JAMEELA
Provider Middle Name:
YASMEEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RPA-C
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:
1194037457
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4979 HARLEM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMHERST
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14226-2547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-923-4380
Provider Business Mailing Address Fax Number:
716-923-4384

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4979 HARLEM RD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
AMHERST
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14226-2547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-923-4380
Provider Business Practice Location Address Fax Number:
716-923-4384
Provider Enumeration Date:
07/02/2010

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: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1065858 . This is a "WELLCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 9516212 . This is a "INDEPENDENT HEALTH ASSOCIATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 9644869 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 100000820625 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 03272539 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2424085 . This is a "COVENTRY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4934736 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3262807 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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