Healthcare Provider Details

I. General information

NPI: 1346790425
Provider Name (Legal Business Name): HANI KHALIL PSYCHIATRIC NURSE PRACTITIONER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2016
Last Update Date: 10/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 ROUTE 55 STE 11
LAGRANGEVILLE NY
12540-5052
US

IV. Provider business mailing address

52 WENNINGTON DR
POUGHKEEPSIE NY
12603-3843
US

V. Phone/Fax

Practice location:
  • Phone: 845-471-2345
  • Fax: 845-471-2223
Mailing address:
  • Phone: 845-471-2345
  • Fax: 845-471-2223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: HANI KHALIL
Title or Position: OWNER
Credential: NPP
Phone: 845-471-2345