Individual provider Active NPI

Muhammad Imran Khan

  • Family Nurse Practitioner
  • Bethpage, NY
National Provider Identifier
1780471235
Registry record updated Apr 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
356601 Issued in NY
Practice address
857 S Oyster Bay Rd
Bethpage, NY 11714-1030
Phone
(516) 622-8888
NPI assigned
Apr 21, 2025
Last updated
Apr 21, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 21, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 356601 NY Primary

Addresses

Primary practice location

857 S Oyster Bay Rd
Bethpage, NY 11714-1030

Mailing address

1464 Astor Ave
Bronx, NY 10469-5813
Phone (516) 286-9429

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250610000758 NY Practitioner - Nurse Practitioner 6709396740 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Charles Evans Center, Inc CurrentSince May 27, 2025 Accepting new patients
Charles Evans Center, Inc. CurrentSince May 27, 2025 Accepting new patients

Locations

857 S Oyster Bay Rd
Bethpage, NY 11714
Phone (516) 622-8888

113 Glen Cove Ave
Glen Cove, NY 11542
Phone (516) 622-8888

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1745193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745193600000",
    "number": "1780471235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1464 ASTOR AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104695813",
            "telephone_number": "516-286-9429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "857 S OYSTER BAY RD",
            "city": "BETHPAGE",
            "state": "NY",
            "postal_code": "117141030",
            "telephone_number": "516-622-8888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "MUHAMMAD",
        "middle_name": "IMRAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-04-21",
        "last_updated": "2025-04-21",
        "certification_date": "2025-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "356601",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bethpage, NY

Sources for this page

Verify at the official NPI Registry.