Active NPI
Surriaya Khanum
- Emergency Medicine Physician
- Wayne, NJ
National Provider Identifier
1508947797
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 25MA03962000
- Practice address
- 103 Timberline Dr
Wayne, NJ 07470-5558 - Phone
- (973) 696-0710
- NPI assigned
- Oct 17, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 25MA03962000 | NJ | Primary |
Addresses
Primary practice location
103 Timberline Dr
Wayne, NJ 07470-5558
Mailing address
103 Timberline Dr
Wayne, NJ 07470-5558
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hoboken Emergency Physicians, PC | Emergency Medicine | Past | Accepting new patients |
| Greenville Hospital | Emergency Medicine | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Emergency Medicine Physician
- Jersey City, NJ
- NPI 1447292727
-
- Emergency Medicine Physician
- Hoboken, NJ
- NPI 1942287883
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1212451200000",
"number": "1508947797",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "103 TIMBERLINE DR",
"city": "WAYNE",
"state": "NJ",
"postal_code": "074705558"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "103 TIMBERLINE DR",
"city": "WAYNE",
"state": "NJ",
"postal_code": "074705558",
"telephone_number": "973-696-0710"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHANUM",
"first_name": "SURRIAYA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-17",
"last_updated": "2008-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "NJ",
"license": "25MA03962000",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wayne, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.