Provider Demographics
NPI:1780608836
Name:KHANNA, ASHOK (MD)
Entity type:Individual
Prefix:
First Name:ASHOK
Middle Name:
Last Name:KHANNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2949 BRIGHTON 4 STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-8511
Mailing Address - Country:US
Mailing Address - Phone:718-934-3353
Mailing Address - Fax:718-769-8428
Practice Address - Street 1:2949 BRIGHTON 4 ST.
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8511
Practice Address - Country:US
Practice Address - Phone:718-934-3353
Practice Address - Fax:718-769-8428
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140688207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00933931Medicaid
NY65D961Medicare PIN
NYB17517Medicare UPIN