Provider Demographics
NPI:1730126889
Name:AL-BARGHOUTHY, NABILA (PA-C)
Entity Type:Individual
Prefix:
First Name:NABILA
Middle Name:
Last Name:AL-BARGHOUTHY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 BENEDICT AVE
Mailing Address - Street 2:THORNWOOD
Mailing Address - City:THORNWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:10594-1204
Mailing Address - Country:US
Mailing Address - Phone:612-532-3131
Mailing Address - Fax:
Practice Address - Street 1:206 BENEDICT AVE
Practice Address - Street 2:
Practice Address - City:THORNWOOD
Practice Address - State:NY
Practice Address - Zip Code:10594-1204
Practice Address - Country:US
Practice Address - Phone:612-532-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9801363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant