Basic Information
| Provider Information | |||||||||
| NPI: | 1386640498 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHOURY-YACOUB | ||||||||
| FirstName: | ANDRE | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 244 WESTCHESTER AVE | ||||||||
| Address2: | STE 103 | ||||||||
| City: | WHITE PLAINS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 106042900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005016388 | ||||||||
| FaxNumber: | 9148722470 | ||||||||
| Practice Location | |||||||||
| Address1: | DAVIS AVE AT E POST RD | ||||||||
| Address2: | |||||||||
| City: | WHITE PLAINS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 106014615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146811260 | ||||||||
| FaxNumber: | 9146812906 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2005 | ||||||||
| LastUpdateDate: | 09/26/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 180234 1 | NY | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.