Provider Demographics
NPI:1689768830
Name:KHOURI, PHILIPPE J (MD)
Entity Type:Individual
Prefix:
First Name:PHILIPPE
Middle Name:J
Last Name:KHOURI
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 1:3626 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-5922
Mailing Address - Country:US
Mailing Address - Phone:609-243-0445
Mailing Address - Fax:609-452-7577
Practice Address - Street 1:905 HERRONTOWN RD
Practice Address - Street 2:PRINCETON HOUSE BEHAVIORAL HEALTH
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-1901
Practice Address - Country:US
Practice Address - Phone:609-497-3300
Practice Address - Fax:609-497-3370
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA048800002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0686000Medicaid
NJF03462Medicare UPIN
NJ192456Medicare ID - Type Unspecified