Provider Demographics
NPI:1689796757
Name:KHALIL, NABIL MOSSAD (MD)
Entity type:Individual
Prefix:
First Name:NABIL
Middle Name:MOSSAD
Last Name:KHALIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7491 JEWETT HOLMWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127
Mailing Address - Country:US
Mailing Address - Phone:716-667-3122
Mailing Address - Fax:716-662-3528
Practice Address - Street 1:9300 LAKE AVE
Practice Address - Street 2:
Practice Address - City:BROCTON
Practice Address - State:NY
Practice Address - Zip Code:14716
Practice Address - Country:US
Practice Address - Phone:716-792-7100
Practice Address - Fax:716-667-3528
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168 189208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice