Provider Demographics
NPI:1598947194
Name:FAKHOURI, ZEIAD ABRAHAM (MD)
Entity Type:Individual
Prefix:
First Name:ZEIAD
Middle Name:ABRAHAM
Last Name:FAKHOURI
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 1:18 WEST RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12569-7923
Mailing Address - Country:US
Mailing Address - Phone:845-223-3333
Mailing Address - Fax:845-223-8248
Practice Address - Street 1:1531 ROUTE 82
Practice Address - Street 2:
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533-3304
Practice Address - Country:US
Practice Address - Phone:845-223-3333
Practice Address - Fax:845-223-8248
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247358207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02948983Medicaid
NY999999OtherPENDING