Healthcare Provider Details

I. General information

NPI: 1548457518
Provider Name (Legal Business Name): WAGDY F GIRGIS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 09/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 BATTERY AVE APT 1
BROOKLYN NY
11228-3555
US

IV. Provider business mailing address

76 BATTERY AVE APT 1
BROOKLYN NY
11228-3555
US

V. Phone/Fax

Practice location:
  • Phone: 718-836-5706
  • Fax: 718-836-7191
Mailing address:
  • Phone: 718-836-5706
  • Fax: 718-836-7191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN006032
License Number StateNY

VIII. Authorized Official

Name: MS. MARYANNE ALESSIO
Title or Position: OFFICE MANAGER
Credential: R.N.
Phone: 718-836-5706