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General NPI Number Information
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NPI Number | 1710475348
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Entity Type | Individual
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Provider Name | MICHAEL BABILA FOGAM MD
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Gender | Male
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Dates
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Enumeration Date | 04/30/2018
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Last Update Date | 06/16/2022
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Provider Practice Location Address
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Address Line | 1111 AMSTERDAM AVE
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City | NEW YORK
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State | NY
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Zip | 10025-1716
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Country | US
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Telephone | 212-523-8158
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Fax |
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Provider Business Mailing Address
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Address Line | 1356 GREENRIDGE AVE
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City | LITHONIA
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State | GA
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Zip | 30058-2210
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Country | US
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Telephone | 912-401-3325
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 311517
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License Number State | NY
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