1376535252 NPI number — TABASSUM YASMIN KHAN M.D.

Table of content: TABASSUM YASMIN KHAN M.D. (NPI 1376535252)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376535252 NPI number — TABASSUM YASMIN KHAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KHAN
Provider First Name:
TABASSUM
Provider Middle Name:
YASMIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1376535252
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
02/11/2019
NPI Reactivation Date:
02/19/2019

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
230 NORTH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POUGHKEEPSIE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12601-1328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-486-2703
Provider Business Mailing Address Fax Number:
845-471-3406

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
223 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEACON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12508-2770
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-838-4900
Provider Business Practice Location Address Fax Number:
845-838-4915
Provider Enumeration Date:
08/17/2005

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: 2084P0800X , with the licence number:  212602-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 212602-1 . This is a "M.D. LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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