Provider Demographics
NPI:1386640498
Name:KHOURY-YACOUB, ANDRE (MD)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:
Last Name:KHOURY-YACOUB
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 1:244 WESTCHESTER AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-2900
Mailing Address - Country:US
Mailing Address - Phone:800-501-6388
Mailing Address - Fax:914-872-2470
Practice Address - Street 1:DAVIS AVE AT E POST RD
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4615
Practice Address - Country:US
Practice Address - Phone:914-681-1260
Practice Address - Fax:914-681-2906
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY180234 12085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY65F301Medicare ID - Type Unspecified
E62475Medicare UPIN