MEDICARE: EKATERINA KHAYTSIS NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	720868	NY
2	363LP2300X	Primary Care Nurse Practitioner	F348863-01	NY
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	405544	NY

General Provider Information

NPI Number	:	1417422395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EKATERINA KHAYTSIS NP

Provider Business Mailing Address
First Line	:	1329 E 17TH ST STE 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6052
Country	:	US
Telephone Number	:	718-382-5060
Fax Number	:

Provider Business Practice Location Address
First Line	:	1329 E 17TH ST STE 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6052
Country	:	US
Telephone Number	:	718-382-5060
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/08/2018
Last Update Date	:	06/03/2024

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