Provider Demographics
NPI:1811963002
Name:KHOURY, SALIM ALBERT (MD)
Entity type:Individual
Prefix:DR
First Name:SALIM
Middle Name:ALBERT
Last Name:KHOURY
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 1:2932 172ND ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-1538
Mailing Address - Country:US
Mailing Address - Phone:718-961-1863
Mailing Address - Fax:718-886-4170
Practice Address - Street 1:2932 172ND ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-1538
Practice Address - Country:US
Practice Address - Phone:718-961-1863
Practice Address - Fax:718-886-4170
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY144891207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00963171Medicaid
NY00963171Medicaid
NY75207Medicare ID - Type Unspecified