Individual
RENAT KHASANOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSN, PMHNP-BC, RN
Contact information
Practice address
75-59 263RD STREET, GLEN OAKS, NY 11004-1100
(718) 470-5750
Mailing address
2266 BATH AVE # 3010, BROOKLYN, NY 11214-5714
(917) 969-6012
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
404349
NY
Other
Enumeration date
08/14/2022
Last updated
09/23/2022
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