Healthcare Provider Details

I. General information

NPI: 1801727656
Provider Name (Legal Business Name): SK NURSE PRACTITIONER IN PSYCHIATRY P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3119 NEWTOWN AVE STE 500
ASTORIA NY
11102-1392
US

IV. Provider business mailing address

3119 NEWTOWN AVE STE 500
ASTORIA NY
11102-1392
US

V. Phone/Fax

Practice location:
  • Phone: 516-515-9595
  • Fax: 516-534-5053
Mailing address:
  • Phone: 516-515-9595
  • Fax: 516-534-5053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SCOTT KOLESAR-KHAN
Title or Position: OWNER
Credential: NP
Phone: 516-515-9595