MEDICARE: HUSSEIN Y ABDELWAHAB, DDS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	046446	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639370380
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUSSEIN Y ABDELWAHAB, DDS, PC

Provider Business Mailing Address
First Line	:	3105 CHURCH AVE
Second Line	:	SUITE 2
City	:	BROOKLYN
State	:	NY
Zip	:	11226-4211
Country	:	US
Telephone Number	:	718-287-1300
Fax Number	:	718-287-5530

Provider Business Practice Location Address
First Line	:	3105 CHURCH AVE
Second Line	:	SUITE 2
City	:	BROOKLYN
State	:	NY
Zip	:	11226-4211
Country	:	US
Telephone Number	:	718-287-1300
Fax Number	:	718-287-5530

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. PAUL J GOMES
Credential	:
Telephone Number	:	917-951-5105

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	08/22/2020

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