Provider Demographics
NPI:1467496364
Name:KHOURY, F FREDERIC (MD)
Entity Type:Individual
Prefix:
First Name:F FREDERIC
Middle Name:
Last Name: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 1:22 RYE RIDGE PLAZA
Mailing Address - Street 2:
Mailing Address - City:RYE BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:10573
Mailing Address - Country:US
Mailing Address - Phone:914-253-9300
Mailing Address - Fax:914-253-9302
Practice Address - Street 1:22 RYE RIDGE PLAZA
Practice Address - Street 2:
Practice Address - City:RYE BROOK
Practice Address - State:NY
Practice Address - Zip Code:10573
Practice Address - Country:US
Practice Address - Phone:914-253-9300
Practice Address - Fax:914-253-9302
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY117574208200000X
CT043207208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA99699Medicare UPIN
NY10A511Medicare PIN