Healthcare Provider Details

I. General information

NPI: 1134140536
Provider Name (Legal Business Name): ED MICHAEL KHOURY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 10/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1184 BRIGHTON BEACH AVE FIRST FLOOR
BROOKLYN NY
11235-5802
US

IV. Provider business mailing address

1184 BRIGHTON BEACH AVE FIRST FLOOR
BROOKLYN NY
11235-5802
US

V. Phone/Fax

Practice location:
  • Phone: 718-833-8777
  • Fax: 718-646-8400
Mailing address:
  • Phone: 718-833-8777
  • Fax: 718-646-8400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number240972
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: