Provider Demographics
NPI:1548712847
Name:MAGDY WAHBA, MD
Entity type:Organization
Organization Name:MAGDY WAHBA, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MAGDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WAHBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-626-0877
Mailing Address - Street 1:PO BOX 665
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07451-0665
Mailing Address - Country:US
Mailing Address - Phone:973-790-0900
Mailing Address - Fax:
Practice Address - Street 1:401 HAMBURG TPKE STE 310
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2139
Practice Address - Country:US
Practice Address - Phone:973-790-5300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03806500207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0218502Medicaid
NJ439682OtherMEDICARE
NJ439682OtherMEDICARE