Provider Demographics
NPI:1598913568
Name:SHAHRIAR J KHALILI MD PC
Entity Type:Organization
Organization Name:SHAHRIAR J KHALILI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INCORPORATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAHRIAR
Authorized Official - Middle Name:J
Authorized Official - Last Name:KHALILI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-447-8300
Mailing Address - Street 1:285 SILLS RD BLDG 14
Mailing Address - Street 2:
Mailing Address - City:E PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4869
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:285 SILLS RD BLDG 14
Practice Address - Street 2:
Practice Address - City:E PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4869
Practice Address - Country:US
Practice Address - Phone:631-447-8300
Practice Address - Fax:631-447-8872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181137207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty