Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | N004635-1 | NY |
NPI | 1417030412 |
---|---|
Provider Name | Mona Khoury |
First Address | Baldwin, NY 11510 |
Second Address | Brooklyn, NY 11229 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 28/01/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02088342 | (05) | NY |
T93222 | (02) | NY |