Doctor Name: | DR. HATEM JASIM MUKHLIS |
NPI Number: | 1346680113 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 164382 |
Business Practice Address: | 344 Twist Run Rd Endwell, NY - 137601028 |
Business Phone Number: | 6077855420 |
Business Fax Number: | 6077855420 |
Mailing Address: | 344 Twist Run Rd, ENDWELL |
State: | NY |
Postal Code: | 137601028 |
Phone Number: | 6077855420 |
Fax Number: | 6077855420 |
NPI Enumeration Date: | 06/26/2013 |
NPI Last Update Date: | 06/26/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QE0002X |
License Number: | 164382 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Emergency Care |
Taxonomy Definition: |