Healthcare Provider Details

I. General information

NPI: 1487924759
Provider Name (Legal Business Name): WAGDY M HABASHY MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 DOW RD
PLAINFIELD CT
06374-1800
US

IV. Provider business mailing address

31 DOW RD
PLAINFIELD CT
06374-1800
US

V. Phone/Fax

Practice location:
  • Phone: 860-564-6296
  • Fax: 860-230-0446
Mailing address:
  • Phone: 860-564-6296
  • Fax: 860-230-0446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0362631
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. WAGDY MOURIN HABASHY
Title or Position: OWNER
Credential: MD
Phone: 860-564-6296