Provider Demographics
NPI:1639782972
Name:HOME PHYSICIAN ASSISTANT SERVICES PC
Entity type:Organization
Organization Name:HOME PHYSICIAN ASSISTANT SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:KHALED
Authorized Official - Middle Name:
Authorized Official - Last Name:ELBANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-321-2331
Mailing Address - Street 1:2119 E 15TH ST STE B1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4376
Mailing Address - Country:US
Mailing Address - Phone:718-339-2901
Mailing Address - Fax:
Practice Address - Street 1:2119 E 15TH ST STE B1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4376
Practice Address - Country:US
Practice Address - Phone:718-339-2901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty