Provider Demographics
NPI:1306146196
Name:GHORAB, DALIA
Entity type:Individual
Prefix:
First Name:DALIA
Middle Name:
Last Name:GHORAB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3134 34TH ST
Mailing Address - Street 2:APT. 3F
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-1789
Mailing Address - Country:US
Mailing Address - Phone:646-247-7381
Mailing Address - Fax:
Practice Address - Street 1:1 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-2901
Practice Address - Country:US
Practice Address - Phone:516-739-2408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055163183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist