Provider Demographics
NPI:1629297296
Name:EL-KHOURY, NICOLAS GEORGES (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:GEORGES
Last Name:EL-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 1:470 77 STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-5901
Mailing Address - Country:US
Mailing Address - Phone:718-809-6329
Mailing Address - Fax:718-833-9164
Practice Address - Street 1:470 77 STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-5901
Practice Address - Country:US
Practice Address - Phone:718-809-6329
Practice Address - Fax:718-833-9164
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179509208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01468006Medicaid
NY03H102Medicare PIN