Provider Demographics
NPI:1124011051
Name:KHOULI, HASSAN E (MD)
Entity type:Individual
Prefix:DR
First Name:HASSAN
Middle Name:E
Last Name:KHOULI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1790 BROADWAY
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1412
Mailing Address - Country:US
Mailing Address - Phone:212-315-0144
Mailing Address - Fax:212-315-0196
Practice Address - Street 1:425 W 59TH ST
Practice Address - Street 2:8TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1104
Practice Address - Country:US
Practice Address - Phone:212-492-5500
Practice Address - Fax:212-492-5505
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2007-10-16
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Provider Licenses
StateLicense IDTaxonomies
NY196500207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01665787Medicaid
NY01665787Medicaid
NYG03776Medicare UPIN