Provider Demographics
NPI:1417092776
Name:NAMI KHULUSI MD LLC
Entity Type:Organization
Organization Name:NAMI KHULUSI MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFF. MGR.
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-819-2920
Mailing Address - Street 1:74 ROUTE 9 NORTH
Mailing Address - Street 2:
Mailing Address - City:ENGLISHTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726
Mailing Address - Country:US
Mailing Address - Phone:718-819-2920
Mailing Address - Fax:718-819-2923
Practice Address - Street 1:74 US HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:ENGLISHTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07726-9209
Practice Address - Country:US
Practice Address - Phone:718-819-2920
Practice Address - Fax:718-819-2923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06313900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty