1770638041 NPI number — DR. SANA YOUSSEF NEJMEH-KHOURY M.D

Table of content: DR. SANA YOUSSEF NEJMEH-KHOURY M.D (NPI 1770638041)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770638041 NPI number — DR. SANA YOUSSEF NEJMEH-KHOURY M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEJMEH-KHOURY
Provider First Name:
SANA
Provider Middle Name:
YOUSSEF
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770638041
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
670 92ND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11228-3632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-833-7466
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
47 78TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11209-2911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-745-2359
Provider Business Practice Location Address Fax Number:
718-745-2378
Provider Enumeration Date:
01/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  225782-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 225782 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7822679 . This is a "AETNA NON-HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02712178 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5C4328 . This is a "HEALTH NET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: NY225782-1 . This is a "1199SEIU" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3818374 . This is a "AETNA HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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