Provider Demographics
NPI:1609045848
Name:NECKLALL KHOOBLALL MD INC
Entity Type:Organization
Organization Name:NECKLALL KHOOBLALL MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NECKLALL
Authorized Official - Middle Name:I
Authorized Official - Last Name:KHOOBLALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-792-9630
Mailing Address - Street 1:253 S CANFIELD NILES RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-4082
Mailing Address - Country:US
Mailing Address - Phone:330-792-9630
Mailing Address - Fax:
Practice Address - Street 1:253 S CANFIELD NILES RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-4082
Practice Address - Country:US
Practice Address - Phone:330-792-9630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH61266207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0896277Medicaid
OHF34767Medicare UPIN
OH0896277Medicaid