Provider Demographics
NPI:1093033904
Name:ALAAELDIN PEDIATRICS, P.C.
Entity Type:Organization
Organization Name:ALAAELDIN PEDIATRICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAAELDIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:MOAWAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-504-5755
Mailing Address - Street 1:393 SUNRISE HWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-5909
Mailing Address - Country:US
Mailing Address - Phone:631-504-5755
Mailing Address - Fax:
Practice Address - Street 1:393 SUNRISE HWY
Practice Address - Street 2:SUITE 2
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-5909
Practice Address - Country:US
Practice Address - Phone:631-504-5755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232607174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI23697Medicare UPIN