Healthcare Provider Details

I. General information

NPI: 1073693966
Provider Name (Legal Business Name): MAGDI BEBAWI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 03/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1827 MADISON AVE
NEW YORK NY
10035-3826
US

IV. Provider business mailing address

51 BURTON AVE
STATEN ISLAND NY
10309-3511
US

V. Phone/Fax

Practice location:
  • Phone: 212-722-1441
  • Fax: 212-722-1445
Mailing address:
  • Phone: 917-502-4664
  • Fax: 570-216-4970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number164464
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: