Basic Information
| Provider Information | |||||||||
| NPI: | 1023106838 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOORI | ||||||||
| FirstName: | KHALID | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 DEER PARK AVENUE | ||||||||
| Address2: | |||||||||
| City: | DEER PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316670388 | ||||||||
| FaxNumber: | 6319687705 | ||||||||
| Practice Location | |||||||||
| Address1: | 1231 DEER PARK AVE | ||||||||
| Address2: | |||||||||
| City: | NORTH BABYLON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316670388 | ||||||||
| FaxNumber: | 6319687705 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 06/27/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 241612 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 241612-1 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.