Individual
PERVEZ ALI KHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2600 SOUTHPARK AVENUE, LACKAWANNA, NY 14218-1504
(716) 822-2028
(716) 822-2029
Mailing address
2600 SOUTHPARK AVENUE, LACKAWANNA, NY 14218-1504
(716) 822-2028
(716) 822-2029
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
125843
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02961200
—
NY
01
—
2197231
COVENTRY
NY
01
—
4538333
AETNA
NY
01
—
RB8099
MEDICARE RAILROAD
NY
Enumeration date
04/09/2008
Last updated
04/05/2017
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