1831409614 NPI number — MAHMOOD A KHAN PRIMARY CARE PC

Table of content: MS. AMY LEA ROBERTS CFNP (NPI 1154302628)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831409614 NPI number — MAHMOOD A KHAN PRIMARY CARE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAHMOOD A KHAN PRIMARY CARE PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1831409614
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5032 STATE HIGHWAY 30
Provider Second Line Business Mailing Address:
MEDICAL PLAZA
Provider Business Mailing Address City Name:
AMSTERDAM
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12010-7534
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-842-0200
Provider Business Mailing Address Fax Number:
518-842-3003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5032 STATE HIGHWAY 30
Provider Second Line Business Practice Location Address:
MEDICAL PLAZA
Provider Business Practice Location Address City Name:
AMSTERDAM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12010-7534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-842-0200
Provider Business Practice Location Address Fax Number:
518-842-3003
Provider Enumeration Date:
10/14/2010

Additional Information

Authorized Official

Authorized Official Last Name:
KHAN
Authorized Official First Name:
MAHMOOD
Authorized Official Middle Name:
AHMAD
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
518-842-0200

Provider Taxonomy Codes

  • Taxonomy code: 207QA0505X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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