Provider Demographics
NPI:1023102464
Name:KHANNA, NEERU (MD)
Entity type:Individual
Prefix:DR
First Name:NEERU
Middle Name:
Last Name:KHANNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NEERU
Other - Middle Name:
Other - Last Name:KOHLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4 PARK VIEW DR
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-9719
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1110 CROSSPOINTE LN
Practice Address - Street 2:SUITE D
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2968
Practice Address - Country:US
Practice Address - Phone:585-872-3390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2014-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272818-1208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics