Provider Demographics
NPI:1346719614
Name:FAIRPORT PSYCHIATRIC ASSOCIATES
Entity Type:Organization
Organization Name:FAIRPORT PSYCHIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHALID
Authorized Official - Middle Name:MAHMOUD
Authorized Official - Last Name:HUBEISHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-388-8020
Mailing Address - Street 1:1387 FAIRPORT RD STE 660
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-2002
Mailing Address - Country:US
Mailing Address - Phone:585-388-8020
Mailing Address - Fax:585-388-8023
Practice Address - Street 1:1387 FAIRPORT RD STE 660
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-2002
Practice Address - Country:US
Practice Address - Phone:585-388-8020
Practice Address - Fax:585-388-8023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty