Individual provider Active NPI

Shahbaz Ali Khan, M.D

  • Anatomic Pathology & Clinical Pathology Physician
  • Staten Island, NY
National Provider Identifier
1639554181
Registry record updated Oct 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
298212 Issued in NY
Practice address
475 Seaview Ave
Staten Island, NY 10305-3436
Phone
(718) 226-4037
NPI assigned
Jul 27, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology (Pathology) Physician 207ZH0000X 298212 NY
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 31464 OK
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 298212 NY Primary

Addresses

Primary practice location

475 Seaview Ave
Staten Island, NY 10305-3436

Mailing address

475 Seaview Ave
Staten Island, NY 10305-3436
Phone (718) 226-4124

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211206001461 NY Practitioner - Pathology 4082951413 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Triborough Gi PLLCGroup PAC ID 2466761531, 15 clinicians
Physician Affiliate Group of New York PCGroup PAC ID 4688098833, 1,222 clinicians

Practice addresses (Care Compare)

129 Saint Nicholas Ave
Brooklyn, NY 11237-4051
Phone (718) 332-0600

1672 Sheepshead Bay Rd
Brooklyn, NY 11235-3803
Phone (718) 332-0600

2601 Ocean Pkwy
Brooklyn, NY 11235-7745
Phone (718) 616-5356

3594 E Tremont Ave
Suite 100
Bronx, NY 10465-2032
Phone (718) 332-0600

Hospital & facility affiliations

  • South Brooklyn Health Hospital, Brooklyn, NY, CCN 330196

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
298212NYMDAnatomic Pathology & Clinical Pathology Physician
31464OKMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Triborough Gi PLLC CurrentSince Jan 25, 2025 Accepting new patients
Physician Affiliate Group of New York PC CurrentSince Mar 17, 2025 Accepting new patients
Triborough Gi PLLC CurrentSince Jan 25, 2025 Accepting new patients
Coney Island Medical Practice Plan, P.C. CurrentSince Aug 8, 2023 Accepting new patients
North Shore-Lij Medical PC CurrentSince Jan 4, 2022 Accepting new patients

Locations

2601 Ocean Pkwy
Brooklyn, NY 11235
Phone (718) 616-5354

1672 Sheepshead Bay Rd
Brooklyn, NY 11235
Phone (718) 795-2734

10201 66th Rd
Forest Hills, NY 11375
Phone (718) 830-4091

506 Malcolm X Blvd
New York, NY 10037
Phone (212) 939-1000

300 Community Dr
Plandome, NY 11030

475 Seaview Ave
Staten Island, NY 10305
Phone (718) 226-8855

375 Seguine Ave
Staten Island, NY 10309
Phone (718) 226-2000

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722

Organizations & group practices 5

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1437955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635552000000",
    "number": "1639554181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 SEAVIEW AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103053436",
            "telephone_number": "718-226-4124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 SEAVIEW AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103053436",
            "telephone_number": "718-226-4037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "SHAHBAZ",
        "middle_name": "ALI",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-07-27",
        "last_updated": "2021-10-30",
        "certification_date": "2021-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZH0000X",
            "taxonomy_group": "",
            "desc": "Pathology, Hematology",
            "state": "NY",
            "license": "298212",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "OK",
            "license": "31464",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NY",
            "license": "298212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.