Provider Demographics
NPI:1134127699
Name:WAHBA, EMAN (MD)
Entity Type:Individual
Prefix:
First Name:EMAN
Middle Name:
Last Name:WAHBA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-723-7778
Mailing Address - Fax:585-723-7925
Practice Address - Street 1:1561 LONG POND RD STE 202
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4135
Practice Address - Country:US
Practice Address - Phone:585-723-7778
Practice Address - Fax:585-723-7925
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY192742207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF60075Medicare UPIN
NYBB7199Medicare PIN