Nabil Mossad Khalil, MD
Individual provider Active NPI General Practice Physician · Brocton, NY
NPI 1689796757 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1689796757
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Physician 208D00000X
- License
- 168 189 (NY)
- Practice address
- 9300 Lake Ave
Brocton, NY 14716 - Phone
- (716) 792-7100
- Fax
- (716) 667-3528
- NPI assigned
- Apr 6, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 168 189 | NY | MD | General Practice Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| State of New York Comptrollers Office | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 168 189 | NY | Yes |
Addresses
Primary practice location
9300 Lake Ave
Brocton, NY 14716
Mailing address
7491 Jewett Holmwood Rd
Orchard Park, NY 14127
Phone (716) 667-3122
Other providers in Brocton, NY
- Wendy Leigh Dellow
- Connor James Dolce
- Patricia Elizabeth Dugan
- Rebecca Ann Giambra
- Donald Dwight Hellert
- Sara Klepfer
- Laura Mackenzie Livengood
- Claudia Anne Monroe
- Laura Lynn Neratko
- Surendra Pattathan
All providers in Brocton, NY · General Practice Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.