Healthcare Provider Details

I. General information

NPI: 1063409282
Provider Name (Legal Business Name): NIDAL MAKHOUL MD FACC FACP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 TOM MILLER ROAD
PLATTSBURGH NY
12901-1252
US

IV. Provider business mailing address

52 TOM MILLER ROAD
PLATTSBURGH NY
12901-1252
US

V. Phone/Fax

Practice location:
  • Phone: 518-563-2404
  • Fax: 518-563-4033
Mailing address:
  • Phone: 518-563-2404
  • Fax: 518-563-4033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number238355
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberE0021551
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: