Healthcare Provider Details

I. General information

NPI: 1679708234
Provider Name (Legal Business Name): KRISHNA PRASAD KHANAL MBBS MD CAQSM FAAFP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2009
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2094 ALBANY POST RD BUILDING # 3
MONTROSE NY
10548-1454
US

IV. Provider business mailing address

1901 VETERAN MEMORIAL DR BUILDING # 163
TEMPLE TX
76504
US

V. Phone/Fax

Practice location:
  • Phone: 914-737-4400
  • Fax: 845-452-6516
Mailing address:
  • Phone: 800-423-2111
  • Fax: 254-743-0135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number39700
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number275691
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberA 121654
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number036.130459
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberS3832
License Number StateTX
# 6
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberS3832
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: