Provider Demographics
NPI:1265860753
Name:IGAL KHORSHIDI, M.D., P.C.
Entity Type:Organization
Organization Name:IGAL KHORSHIDI, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IGAL
Authorized Official - Middle Name:
Authorized Official - Last Name:KHORSHIDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-456-0304
Mailing Address - Street 1:888 PARK AVE
Mailing Address - Street 2:SUITE #1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0235
Mailing Address - Country:US
Mailing Address - Phone:212-734-0000
Mailing Address - Fax:212-679-6160
Practice Address - Street 1:888 PARK AVE
Practice Address - Street 2:SUITE #1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0235
Practice Address - Country:US
Practice Address - Phone:212-734-0000
Practice Address - Fax:212-679-6160
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IGAL KHORSHIDI, M.D., P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY256986207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty