Healthcare Provider Details

I. General information

NPI: 1689768830
Provider Name (Legal Business Name): PHILIPPE J. KHOURI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 HERRONTOWN RD PRINCETON HOUSE BEHAVIORAL HEALTH
PRINCETON NJ
08540-1901
US

IV. Provider business mailing address

3626 US HIGHWAY 1
PRINCETON NJ
08540-5922
US

V. Phone/Fax

Practice location:
  • Phone: 609-497-3300
  • Fax: 609-497-3370
Mailing address:
  • Phone: 609-243-0445
  • Fax: 609-452-7577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA04880000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: