1558161976 NPI number — MAHA GHORAYEB NP IN FAMILY HEALTH, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558161976 NPI number — MAHA GHORAYEB NP IN FAMILY HEALTH, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAHA GHORAYEB NP IN FAMILY HEALTH, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1558161976
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 INDEPENDENCE ROW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STILLWATER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12170-1340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-203-8109
Provider Business Mailing Address Fax Number:
518-203-8109

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 INDEPENDENCE ROW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STILLWATER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12170-1340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-203-8109
Provider Business Practice Location Address Fax Number:
518-203-8109
Provider Enumeration Date:
03/14/2025

Additional Information

Authorized Official

Authorized Official Last Name:
GHORAYEB
Authorized Official First Name:
MAHA
Authorized Official Middle Name:
Authorized Official Title or Position:
FOUNDER
Authorized Official Telephone Number:
518-203-8109

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , registered in the state of NULL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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