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General NPI Number Information
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NPI Number | 1376704999
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Entity Type | Individual
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Provider Name | FARJALLAH NASSIM KHOURY I M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/17/2008
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 1650 CHAMPLIN AVE
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City | UTICA
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State | NY
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Zip | 13502-4801
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Country | US
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Telephone | 315-624-8400
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Fax | 315-624-8698
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Provider Business Mailing Address
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Address Line | 111 HOSPITAL DR
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City | UTICA
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State | NY
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Zip | 13502-2517
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Country | US
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Telephone | 315-801-8534
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Fax | 315-801-8391
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 335053
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | A112452
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License Number State | CA
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