Provider Demographics
NPI:1013000660
Name:KHOSH, MAURICE M (MD)
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:M
Last Name:KHOSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 20988
Mailing Address - Street 2:COLUMBUS CIRCLE STATION
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023
Mailing Address - Country:US
Mailing Address - Phone:212-262-4444
Mailing Address - Fax:212-523-8165
Practice Address - Street 1:425 WEST 59TH STREET
Practice Address - Street 2:10TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:212-262-4444
Practice Address - Fax:212-523-8165
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188633-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01872802Medicaid
NY01872802Medicaid
NY39E9755F051Medicare PIN
NYG37044Medicare UPIN