=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598468662
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WASSEF MEDICAL SERVICES PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2023
-----------------------------------------------------
Last Update Date | 03/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 511 6TH AVE UNIT 233
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10011-8436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-810-9893
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 511 6TH AVE UNIT 233
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10011-8436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-810-9893
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | FADY WASSEF
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 917-810-9893
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------