Provider Demographics
NPI:1043690597
Name:ST ANTHONY MEDICAL SERVICES PC
Entity Type:Organization
Organization Name:ST ANTHONY MEDICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:EL-KHOURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-833-9148
Mailing Address - Street 1:470 77TH ST
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3206
Mailing Address - Country:US
Mailing Address - Phone:718-833-9148
Mailing Address - Fax:718-833-9164
Practice Address - Street 1:5910 JUNCTION BLVD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5156
Practice Address - Country:US
Practice Address - Phone:718-833-9148
Practice Address - Fax:718-833-9164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-30
Last Update Date:2015-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179509208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty