Individual
DR. KHURRAM MEHTABDIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
301 E MAIN ST, BAY SHORE, NY 11706-8408
(631) 422-0205
Mailing address
301 E MAIN ST, BAY SHORE, NY 11706-8408
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
279108
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/24/2014
Last updated
03/17/2018
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