Provider Demographics
NPI:1083663744
Name:GHOBRIAL, MICHEL WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHEL
Middle Name:WILLIAM
Last Name:GHOBRIAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 MAIN ST
Mailing Address - Street 2:SUITE 12
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-6922
Mailing Address - Country:US
Mailing Address - Phone:631-271-6406
Mailing Address - Fax:
Practice Address - Street 1:124 MAIN ST
Practice Address - Street 2:SUITE 12
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-6922
Practice Address - Country:US
Practice Address - Phone:631-271-6406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234668207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY202343976OtherHORIZON
NY291AZ1OtherEMPIRE BLUE CROSS BLUE SH
NY202343976OtherTHE EMPIRE PLAN
NYP3598607OtherOXFORD
NY202343976OtherMAGNACARE
NY4772468OtherCIGNA
NY2590158OtherGHI
NY202343976OtherHORIZON
NY202343976OtherMAGNACARE