Healthcare Provider Details

I. General information

NPI: 1265534820
Provider Name (Legal Business Name): SUZAN Y KHALIL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2006
Last Update Date: 03/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 GREENBROOK RD
GREEN BROOK NJ
08812-2223
US

IV. Provider business mailing address

275 GREENBROOK RD
GREEN BROOK NJ
08812-2223
US

V. Phone/Fax

Practice location:
  • Phone: 732-968-2401
  • Fax: 732-968-8125
Mailing address:
  • Phone: 732-968-2401
  • Fax: 732-968-8125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA06051600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: