Provider Demographics
NPI:1861990863
Name:IHAB GIRGIS, PHD, LCSW, PLLC
Entity type:Organization
Organization Name:IHAB GIRGIS, PHD, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:IHAB
Authorized Official - Middle Name:
Authorized Official - Last Name:GIRGIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSWR
Authorized Official - Phone:917-648-0885
Mailing Address - Street 1:210 INGRAHAM LN
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-4240
Mailing Address - Country:US
Mailing Address - Phone:917-648-0885
Mailing Address - Fax:
Practice Address - Street 1:107 NORTHERN BLVD STE 202
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4309
Practice Address - Country:US
Practice Address - Phone:917-648-0885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0758271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty