1437556024 NPI number — DR. KHALED ALMANSOORI MD, M.ED, MBBCH

Table of content: (NPI 1083886485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437556024 NPI number — DR. KHALED ALMANSOORI MD, M.ED, MBBCH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALMANSOORI
Provider First Name:
KHALED
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, M.ED, MBBCH
Provider Gender Code:
M

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:
1437556024
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 BREWSTER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLEN COVE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11542-2549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
929-442-3181
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6701 W 95TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAK LAWN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60453-2105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-599-5000
Provider Business Practice Location Address Fax Number:
708-599-0801
Provider Enumeration Date:
11/25/2014

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: 207X00000X , with the licence number:  MD042563 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: MD042563 . This is a "WASHINGTON DC MEDICAL LICENSE NUMBER" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: W14092132C . This is a "WASHINGTON DRUG REGISTRATION CONTROL NUMBER" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 036150671 . This is a "IL MEDICAL LICENSE NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 292542 . This is a "NY MEDICAL LICENSE NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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