Provider Demographics
NPI:1265536478
Name:KHORIATY, FLORENCE FARES (MD)
Entity type:Individual
Prefix:
First Name:FLORENCE
Middle Name:FARES
Last Name:KHORIATY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50-01 207 STREET
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-1114
Mailing Address - Country:US
Mailing Address - Phone:718-423-0310
Mailing Address - Fax:718-229-1902
Practice Address - Street 1:50-01 207 STREET
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-1114
Practice Address - Country:US
Practice Address - Phone:718-423-0310
Practice Address - Fax:718-229-1902
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY157851208000000X
FLME94131208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
D04021Medicare UPIN