Provider Demographics
NPI:1144876913
Name:KHAN, ASIF JALIL
Entity type:Individual
Prefix:
First Name:ASIF
Middle Name:JALIL
Last Name:KHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:SAUGERTIES
Mailing Address - State:NY
Mailing Address - Zip Code:12477-1418
Mailing Address - Country:US
Mailing Address - Phone:845-532-2381
Mailing Address - Fax:845-338-2100
Practice Address - Street 1:110 W BRIDGE ST
Practice Address - Street 2:
Practice Address - City:SAUGERTIES
Practice Address - State:NY
Practice Address - Zip Code:12477-1418
Practice Address - Country:US
Practice Address - Phone:845-532-2381
Practice Address - Fax:845-338-2100
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty