Provider Demographics
NPI:1457341158
Name:KHOURY-YACOUB, NABIL (MD)
Entity Type:Individual
Prefix:
First Name:NABIL
Middle Name:
Last Name:KHOURY-YACOUB
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 1:170 MAPLE AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-4710
Mailing Address - Country:US
Mailing Address - Phone:914-328-8444
Mailing Address - Fax:914-328-8414
Practice Address - Street 1:170 MAPLE AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4710
Practice Address - Country:US
Practice Address - Phone:914-328-8444
Practice Address - Fax:914-328-8414
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194841207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01502221Medicaid
NY821C21Medicare PIN
NY08G761Medicare PIN
NYG-06664Medicare UPIN
NY01502221Medicaid