Provider Demographics
NPI:1699932038
Name:KHANNA, MINAKSHI (PA)
Entity type:Individual
Prefix:
First Name:MINAKSHI
Middle Name:
Last Name:KHANNA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176-60 UNION TPKE
Mailing Address - Street 2:SUITE 360
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366
Mailing Address - Country:US
Mailing Address - Phone:718-460-2300
Mailing Address - Fax:718-460-9697
Practice Address - Street 1:176-60 UNION TPKE
Practice Address - Street 2:SUITE 360
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366
Practice Address - Country:US
Practice Address - Phone:718-460-2300
Practice Address - Fax:718-460-9697
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010592363A00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY010592OtherNEW YORK STATE LICENSE
NY010592OtherNEW YORK STATE LICENSE