1619613684 NPI number — MUHAMMAD JAHANZAIB KHAN

Table of content: LIZA HOLLENBECK LLMSW (NPI 1851102768)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619613684 NPI number — MUHAMMAD JAHANZAIB KHAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KHAN
Provider First Name:
MUHAMMAD JAHANZAIB
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

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:
1619613684
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
12/27/2022
NPI Reactivation Date:
12/19/2023

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
84 NORTH COUNTRY ROAD, APT C10
Provider Second Line Business Mailing Address:
APT C10
Provider Business Mailing Address City Name:
PORT JEFFERSON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11777
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-202-9755
Provider Business Mailing Address Fax Number:
631-686-7651

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 N COUNTRY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT JEFFERSON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11777-2190
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-686-2549
Provider Business Practice Location Address Fax Number:
631-686-7651
Provider Enumeration Date:
05/11/2022

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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