Basic Information
| Provider Information | |||||||||
| NPI: | 1114067667 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHAN | ||||||||
| FirstName: | MANSOOR | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 CENTURY DR | ||||||||
| Address2: | |||||||||
| City: | PARSIPPANY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070544610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003450064 | ||||||||
| FaxNumber: | 9737401350 | ||||||||
| Practice Location | |||||||||
| Address1: | 224 HAMBURG TPKE | ||||||||
| Address2: | WAYNE GENERAL HOSPITAL | ||||||||
| City: | WAYNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074702111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737542150 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2007 | ||||||||
| LastUpdateDate: | 04/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | R5881 | TX | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 25MA08206300 | NJ | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.