Provider Demographics
NPI:1437492162
Name:KHANNA, NEHA (DPM)
Entity Type:Individual
Prefix:
First Name:NEHA
Middle Name:
Last Name:KHANNA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-8140
Mailing Address - Country:US
Mailing Address - Phone:718-840-0600
Mailing Address - Fax:718-840-0653
Practice Address - Street 1:702 8TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-8140
Practice Address - Country:US
Practice Address - Phone:718-840-0600
Practice Address - Fax:718-840-0653
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006792213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400159916Medicare PIN