Provider Demographics
NPI:1225204274
Name:MARZOUK, HAIDY ADLY (MD)
Entity Type:Individual
Prefix:
First Name:HAIDY
Middle Name:ADLY
Last Name:MARZOUK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HAIDY
Other - Middle Name:ADLY
Other - Last Name:BIBAWY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5111 WATERFORD WOOD WAY
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-8704
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:750 E ADAMS ST
Practice Address - Street 2:DEPT. OF OTOLARYNGOLOGY
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2306
Practice Address - Country:US
Practice Address - Phone:315-464-5540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY260241207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology