Healthcare Provider Details

I. General information

NPI: 1982538237
Provider Name (Legal Business Name): NADA DECRUSE WAANBAH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WOODHULL / NYC HEALTH HOSPITALS 760 BROADWAY, PEDIATRIC ADMINISTRATION / 6TH FLOOR
BROOKLYN NY
11206
US

IV. Provider business mailing address

WOODHULL / NYC HEALTH HOSPITALS 760 BROADWAY, PEDIATRIC ADMINISTRATION / 6TH FLOOR
BROOKLYN NY
11206
US

V. Phone/Fax

Practice location:
  • Phone: 718-963-8779
  • Fax: 718-963-7957
Mailing address:
  • Phone: 718-963-8779
  • Fax: 718-963-7957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: