Provider Demographics
NPI:1497781546
Name:WAHBA, MAGDY (MD)
Entity Type:Individual
Prefix:DR
First Name:MAGDY
Middle Name:
Last Name:WAHBA
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:PO BOX 665
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07451-0665
Mailing Address - Country:US
Mailing Address - Phone:973-790-0900
Mailing Address - Fax:973-790-0900
Practice Address - Street 1:401 HAMBURG TPKE
Practice Address - Street 2:SUITE 310
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2154
Practice Address - Country:US
Practice Address - Phone:973-790-5300
Practice Address - Fax:973-790-0900
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03806500207RP1001X, 207RC0200X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ439682OtherMEDICARE
NJ0218502Medicaid
NJ0218502Medicaid
NJ439682Medicare PIN