Provider Demographics
NPI:1275192320
Name:KHANAL, SANTOSH
Entity Type:Individual
Prefix:
First Name:SANTOSH
Middle Name:
Last Name:KHANAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4705 48TH ST APT 2B
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-6602
Mailing Address - Country:US
Mailing Address - Phone:260-705-4266
Mailing Address - Fax:
Practice Address - Street 1:4705 48TH ST APT 2B
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-6602
Practice Address - Country:US
Practice Address - Phone:260-705-4266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty