Healthcare Provider Details

I. General information

NPI: 1487008355
Provider Name (Legal Business Name): ISSA SAMIR KHOURY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 05/20/2022
Certification Date: 05/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

967 N BROADWAY
YONKERS NY
10701-1301
US

IV. Provider business mailing address

967 N BROADWAY
YONKERS NY
10701-1301
US

V. Phone/Fax

Practice location:
  • Phone: 914-964-4444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number30802601
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: