Healthcare Provider Details

I. General information

NPI: 1962675447
Provider Name (Legal Business Name): MEDICAL SERVICES OF AMERICA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2008
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 RONKONKOMA AVE
RONKONKOMA NY
11779-9998
US

IV. Provider business mailing address

210 RONKONKOMA AVE
RONKONKOMA NY
11779-3346
US

V. Phone/Fax

Practice location:
  • Phone: 631-780-6611
  • Fax: 631-780-6624
Mailing address:
  • Phone: 631-780-6611
  • Fax: 631-780-6624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WAJDY L HAILOO
Title or Position: PRESIDENT
Credential: MD
Phone: 631-780-6611