Provider Demographics
NPI:1831860907
Name:KHAN, SAFDER ALI (PA-C)
Entity type:Individual
Prefix:
First Name:SAFDER
Middle Name:ALI
Last Name:KHAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 S BROADWAY APT 3B
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-4580
Mailing Address - Country:US
Mailing Address - Phone:209-403-1003
Mailing Address - Fax:
Practice Address - Street 1:2951 GRAND CONCOURSE APT 1A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-1431
Practice Address - Country:US
Practice Address - Phone:718-220-4210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027281363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant