Provider Demographics
NPI:1114039799
Name:EL KHOURY, NAJI SA (MD)
Entity Type:Individual
Prefix:
First Name:NAJI
Middle Name:SA
Last Name:EL KHOURY
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 1:77 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-2336
Mailing Address - Country:US
Mailing Address - Phone:315-732-6100
Mailing Address - Fax:315-732-5542
Practice Address - Street 1:77 GENESEE ST
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-2336
Practice Address - Country:US
Practice Address - Phone:315-732-6100
Practice Address - Fax:315-732-5542
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1991851207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYSP060Medicaid
NY01561128Medicaid
NY115015OtherMVP
G12452Medicare UPIN
NY01561128Medicaid