Provider Demographics
NPI:1487768073
Name:KHOURI, PETER (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:KHOURI
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 1:400 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3417
Mailing Address - Country:US
Mailing Address - Phone:914-666-1371
Mailing Address - Fax:914-666-1952
Practice Address - Street 1:NORTHERN WESTCHESTER HOSPITAL
Practice Address - Street 2:400 EAST MAIN ST
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549
Practice Address - Country:US
Practice Address - Phone:914-666-1371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2067262085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG36365Medicare UPIN