Provider Demographics
NPI:1952545899
Name:KATANOV, KHANA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KHANA
Middle Name:
Last Name:KATANOV
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13411 KEW GARDENS RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-1930
Mailing Address - Country:US
Mailing Address - Phone:646-409-9011
Mailing Address - Fax:718-261-0170
Practice Address - Street 1:13411 KEW GARDENS RD
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418
Practice Address - Country:US
Practice Address - Phone:646-409-9011
Practice Address - Fax:718-261-0170
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-22
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007273174400000X
NY017406174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist