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General NPI Number Information
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NPI Number | 1811946767
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Entity Type | Individual
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Provider Name | IAN L BOURHILL MD
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Gender | Male
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Dates
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Enumeration Date | 05/09/2006
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Last Update Date | 09/14/2023
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Provider Practice Location Address
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Address Line | 205 E MAIN ST STE 1-6
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City | HUNTINGTON
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State | NY
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Zip | 11743-7930
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Country | US
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Telephone | 631-424-4026
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Fax | 631-424-4046
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Provider Business Mailing Address
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Address Line | 205 E MAIN ST STE 1-6
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City | HUNTINGTON
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State | NY
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Zip | 11743-7930
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Country | US
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Telephone | 631-424-4026
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Fax | 866-427-7103
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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 | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 190175
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License Number State | NY
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