Healthcare Provider Details

I. General information

NPI: 1497781546
Provider Name (Legal Business Name): MAGDY WAHBA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 HAMBURG TPKE SUITE 310
WAYNE NJ
07470-2154
US

IV. Provider business mailing address

PO BOX 665
RIDGEWOOD NJ
07451-0665
US

V. Phone/Fax

Practice location:
  • Phone: 973-790-5300
  • Fax: 973-790-0900
Mailing address:
  • Phone: 973-790-0900
  • Fax: 973-790-0900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25MA03806500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number25MA03806500
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number25MA03806500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: