Provider Demographics
NPI:1922029701
Name:KHABIE, VICTOR (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:KHABIE
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 1:664 STONELEIGH AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-3990
Mailing Address - Country:US
Mailing Address - Phone:845-278-8400
Mailing Address - Fax:845-278-4326
Practice Address - Street 1:664 STONELEIGH AVE STE 300
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-3990
Practice Address - Country:US
Practice Address - Phone:845-278-8400
Practice Address - Fax:845-278-4326
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT53412174400000X
NY198494174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY200045545OtherRAILROAD MEDICARE
NYP00017570OtherRAILROAD MEDICARE
NY4682510001OtherMEDICARE
NYP00017570OtherRAILROAD MEDICARE
NYG34549Medicare UPIN
NY75G791Medicare PIN
NY4682510003Medicare NSC