Provider Demographics
NPI:1205978301
Name:KIRIDLY, NABIL KHORSHID (MD)
Entity type:Individual
Prefix:DR
First Name:NABIL
Middle Name:KHORSHID
Last Name:KIRIDLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:267 E MAIN ST
Mailing Address - Street 2:BLDG- B
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2874
Mailing Address - Country:US
Mailing Address - Phone:631-366-2220
Mailing Address - Fax:631-366-1018
Practice Address - Street 1:267 E MAIN ST
Practice Address - Street 2:BLDG- B
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2874
Practice Address - Country:US
Practice Address - Phone:631-366-2220
Practice Address - Fax:631-366-1018
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1682972086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY62K471Medicare ID - Type Unspecified
NYF27698Medicare UPIN