Provider Demographics
NPI:1396835047
Name:MOAWAD, ALAAELDIN F (MD)
Entity Type:Individual
Prefix:
First Name:ALAAELDIN
Middle Name:F
Last Name:MOAWAD
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 1:393 SUNRISE HIGHWAY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704
Mailing Address - Country:US
Mailing Address - Phone:631-504-5755
Mailing Address - Fax:631-504-5756
Practice Address - Street 1:393 SUNRISE HIGHWAY
Practice Address - Street 2:SUITE 2
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704
Practice Address - Country:US
Practice Address - Phone:631-504-5755
Practice Address - Fax:631-504-5756
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232607208000000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI23697Medicare UPIN
NY612Y81Medicare ID - Type Unspecified