1639929524 NPI number — DR. NADA RAAFAT ABDULRAOUF KHATTAB MBBCH

Table of content: DR. NADA RAAFAT ABDULRAOUF KHATTAB MBBCH (NPI 1639929524)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639929524 NPI number — DR. NADA RAAFAT ABDULRAOUF KHATTAB MBBCH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KHATTAB
Provider First Name:
NADA
Provider Middle Name:
RAAFAT ABDULRAOUF
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MBBCH
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:
1639929524
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HEALTH SCIENCE TOWER LEVEL 19, ROOM 30
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STONY BROOK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11794-8191
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-444-1791
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 NICOLLS ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STONY BROOK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11794
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-689-8333
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/25/2024

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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