Provider Demographics
NPI:1033186002
Name:KHAN, SAJID ALI (MD)
Entity type:Individual
Prefix:DR
First Name:SAJID
Middle Name:ALI
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2120
Mailing Address - Country:US
Mailing Address - Phone:607-729-4942
Mailing Address - Fax:607-729-7516
Practice Address - Street 1:200 FRONT ST
Practice Address - Street 2:SUITE C
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-1559
Practice Address - Country:US
Practice Address - Phone:607-748-7468
Practice Address - Fax:607-748-7469
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0064244208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDI60088Medicare UPIN