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General NPI Number Information
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NPI Number | 1760892384
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Entity Type | Individual
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Provider Name | ELISA KHANNA
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Gender | Female
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Dates
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Enumeration Date | 05/05/2014
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Last Update Date | 01/13/2017
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Provider Practice Location Address
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Address Line | 8519 263RD ST
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City | FLORAL PARK
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State | NY
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Zip | 11001-1137
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Country | US
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Telephone | 516-466-5222
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Fax |
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Provider Business Mailing Address
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Address Line | 488 GREAT NECK RD
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City | GREAT NECK
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State | NY
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Zip | 11021-4315
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Country | US
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Telephone | 917-225-2538
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 058281-1
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License Number State | NY
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