Healthcare Provider Details

I. General information

NPI: 1083971311
Provider Name (Legal Business Name): DAWIT WUBISHET MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 12/15/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 BEACH 19TH ST
FAR ROCKAWAY NY
11691-4423
US

IV. Provider business mailing address

2004 SEAGIRT BLVD 5G
FAR ROCKAWAY NY
11691-2802
US

V. Phone/Fax

Practice location:
  • Phone: 718-869-7000
  • Fax:
Mailing address:
  • Phone: 240-421-7554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number112222
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35099224
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: