Organization
SOUTHERN TIER PEDIATRICS PRACTICE, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARIQ M KHAN M.D. (PRESIDENT)
(716) 661-9730
Entity
Organization
Contact information
Practice address
1684 FOOTE AVENUE EXT, JAMESTOWN, NY 14701-9385
(716) 661-9730
(716) 661-9732
Mailing address
1684 FOOTE AVENUE EXT, JAMESTOWN, NY 14701-9385
(716) 661-9730
(716) 661-9732
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
207469
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01664951
—
NY
05
—
02690682
—
NY
Enumeration date
07/13/2006
Last updated
05/15/2013
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