Healthcare Provider Details

I. General information

NPI: 1548712847
Provider Name (Legal Business Name): MAGDY WAHBA, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

401 HAMBURG TPKE STE 310
WAYNE NJ
07470-2139
US

IV. Provider business mailing address

PO BOX 665
RIDGEWOOD NJ
07451-0665
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MAGDY WAHBA
Title or Position: PHYSICIAN
Credential: MD
Phone: 917-626-0877