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General NPI Number Information
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NPI Number | 1417422395
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Entity Type | Individual
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Provider Name | EKATERINA KHAYTSIS NP
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Gender | Female
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Dates
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Enumeration Date | 10/08/2018
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 1329 E 17TH ST STE 1
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City | BROOKLYN
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State | NY
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Zip | 11230-6052
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Country | US
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Telephone | 718-382-5060
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Fax |
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Provider Business Mailing Address
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Address Line | 1329 E 17TH ST STE 1
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City | BROOKLYN
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State | NY
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Zip | 11230-6052
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Country | US
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Telephone | 718-382-5060
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 405544
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | F348863-01
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 720868
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License Number State | NY
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