Provider Demographics
NPI:1871930073
Name:IGAL KHORSHIDI, M.D., P.C.
Entity type:Organization
Organization Name:IGAL KHORSHIDI, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IGAL
Authorized Official - Middle Name:
Authorized Official - Last Name:KHORSHIDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-456-0304
Mailing Address - Street 1:7911 41ST AVE
Mailing Address - Street 2:A108
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1258
Mailing Address - Country:US
Mailing Address - Phone:212-734-0000
Mailing Address - Fax:646-661-2795
Practice Address - Street 1:7911 41ST AVE
Practice Address - Street 2:A108
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1258
Practice Address - Country:US
Practice Address - Phone:212-734-0000
Practice Address - Fax:646-661-2795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-29
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY256986207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03540943Medicaid