Healthcare Provider Details

I. General information

NPI: 1023018231
Provider Name (Legal Business Name): JOSEPH WAHBA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3680 BEDFORD AVE
BROOKLYN NY
11229-1704
US

IV. Provider business mailing address

3680 BEDFORD AVE
BROOKLYN NY
11229-1704
US

V. Phone/Fax

Practice location:
  • Phone: 718-338-5542
  • Fax: 718-677-9859
Mailing address:
  • Phone: 718-338-5542
  • Fax: 718-677-9859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number187531
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: