Provider Demographics
NPI:1659506731
Name:KHAN, MISBAH HUZAIRA (MD)
Entity type:Individual
Prefix:
First Name:MISBAH
Middle Name:HUZAIRA
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 E 37TH ST RM 317
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3256
Mailing Address - Country:US
Mailing Address - Phone:917-853-3376
Mailing Address - Fax:
Practice Address - Street 1:345 E 37TH ST RM 317
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3256
Practice Address - Country:US
Practice Address - Phone:917-853-3376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251469207N00000X, 207ND0101X, 207NS0135X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology