Basic Information
| Provider Information | |||||||||
| NPI: | 1336260157 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHOURY | ||||||||
| FirstName: | THERESE | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | RPA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 ATRIUM DR STE 100 | ||||||||
| Address2: | ATTN TAMMY M. BUTTON | ||||||||
| City: | ALBANY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 122051441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184352740 | ||||||||
| FaxNumber: | 5184582610 | ||||||||
| Practice Location | |||||||||
| Address1: | 4 PALISADES DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ALBANY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 122051443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184469545 | ||||||||
| FaxNumber: | 5184469551 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2007 | ||||||||
| LastUpdateDate: | 08/22/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 006673 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.