Healthcare Provider Details

I. General information

NPI: 1629701669
Provider Name (Legal Business Name): NACIR DHOUIBI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 MITCHELL AVE STE 102
BINGHAMTON NY
13903-1642
US

IV. Provider business mailing address

33 MITCHELL AVE STE 102
BINGHAMTON NY
13903-1642
US

V. Phone/Fax

Practice location:
  • Phone: 607-762-3281
  • Fax: 607-762-3295
Mailing address:
  • Phone: 607-762-3281
  • Fax: 607-762-3295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME172159
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: