Provider Demographics
NPI:1073693966
Name:BEBAWI, MAGDI (MD)
Entity Type:Individual
Prefix:DR
First Name:MAGDI
Middle Name:
Last Name:BEBAWI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 BURTON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-3511
Mailing Address - Country:US
Mailing Address - Phone:917-502-4664
Mailing Address - Fax:570-216-4970
Practice Address - Street 1:1827 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-3826
Practice Address - Country:US
Practice Address - Phone:212-722-1441
Practice Address - Fax:212-722-1445
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164464174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01491203Medicaid
NY01491203Medicaid
NY03E743Medicare ID - Type UnspecifiedPHYSICIAN
NYA60062Medicare UPIN