Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 231492 | NY |
Y | 2081P2900X | Pain Medicine | 231492 | NY |
NPI | 1104893619 |
---|---|
Provider Name | Muhammad Mustafa Khan |
First Address | Smithtown, NY 11787-2978 |
Second Address | Smithtown, NY 11787-2978 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2006 |
Last Update Date | 07/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2105284 | (05) | MA |
I35540 | (02) | MA |