Provider Demographics
NPI:1093125809
Name:EL KHOURY, LARA (MD)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:
Last Name:EL KHOURY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 NORTHERN BLVD STE 302
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5310
Mailing Address - Country:US
Mailing Address - Phone:516-708-2550
Mailing Address - Fax:516-708-2597
Practice Address - Street 1:865 NORTHERN BLVD STE 302
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5310
Practice Address - Country:US
Practice Address - Phone:516-708-2550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-01
Last Update Date:2019-04-25
Deactivation Date:2014-12-03
Deactivation Code:
Reactivation Date:2015-03-10
Provider Licenses
StateLicense IDTaxonomies
NY289725207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology