Healthcare Provider Details

I. General information

NPI: 1528609591
Provider Name (Legal Business Name): MINA FAWZY MAGDY KHEIR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2019
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 KENT AVE APT 325
BROOKLYN NY
11249-5296
US

IV. Provider business mailing address

515 W 38TH ST APT 10H
NEW YORK NY
10018-1195
US

V. Phone/Fax

Practice location:
  • Phone: 917-915-2090
  • Fax:
Mailing address:
  • Phone: 917-915-2090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number06151101
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: