Look up the most recent NPI and PECOS records

Ali Shah Khan

Emergency Medicine

Allopathic & Osteopathic Physicians

Hsc Level 4 Room 080 Stony Brook Hospital, Stony Brook, NY 11794-0001

PECOS Enrollment

This provider is enrolled in PECOS as ALI KHAN.

Based on the most recent information from CMS, provider Ali Shah Khan is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 4 days ago.

Profile Details

Provider ID
1225560469
Provider Type
Individual
Full Name
Khan, Ali Shah
Title
Dr.
Credential
M.D.

Gender
Male
Sole Proprietor
No
Enumeration Date
3/28/2017
Last Updated
5/21/2020

Contact Information

Practice Location

Hsc Level 4 Room 080 Stony Brook Hospital, Stony Brook, NY 11794-0001

(631) 444-3880

(631) 444-3919

Mailing Location

Hsc Level 4 Room 080 Stony Brook Hospital, Stony Brook, NY 11794-0001

(631) 444-3880

(631) 444-3919

Provider Taxonomies

Code	Description	License
Code 207P00000X Primary	Description Emergency Medicine Allopathic & Osteopathic Physicians	License 304949 New York
Code 390200000X	Description Student in an Organized Health Care Education/Training Program Student, Health Care	License Unlisted Issuer Texas

Ali Shah Khan

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

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