Healthcare Provider Details

I. General information

NPI: 1689796757
Provider Name (Legal Business Name): NABIL MOSSAD KHALIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 LAKE AVE
BROCTON NY
14716
US

IV. Provider business mailing address

7491 JEWETT HOLMWOOD RD
ORCHARD PARK NY
14127
US

V. Phone/Fax

Practice location:
  • Phone: 716-792-7100
  • Fax: 716-667-3528
Mailing address:
  • Phone: 716-667-3122
  • Fax: 716-662-3528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number168 189
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: