Healthcare Provider Details

I. General information

NPI: 1952858581
Provider Name (Legal Business Name): NADIA KHALIL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 LIVING TON STREET
BROOKLYN NY
11221
US

IV. Provider business mailing address

641 HART STREET
BROOKLYN NY
11221
US

V. Phone/Fax

Practice location:
  • Phone: 718-625-4055
  • Fax:
Mailing address:
  • Phone: 917-579-3474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: