Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 168297 | NY |
NPI | 1205978301 |
---|---|
Provider Name | Dr. Nabil Khorshid Kiridly |
First Address | Smithtown, NY 11787-2874 |
Second Address | Smithtown, NY 11787-2874 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F27698 | (02) | NY |