Individual
DR. KHALED OMAR ELBANNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2543 STEINWAY STREET, ASTORIA, NY 11103
(718) 706-8060
(718) 706-8650
Mailing address
2543 STEINWAY STREET, ASTORIA, NY 11103-3503
(718) 706-8060
(718) 707-8650
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
224801-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4C7293
HEALTHNET
NY
Enumeration date
05/05/2006
Last updated
02/01/2021
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