Provider Demographics
NPI:1497848808
Name:MAHDY-GEWAILY, OLFAT HASSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:OLFAT
Middle Name:HASSAN
Last Name:MAHDY-GEWAILY
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 1:7901 BROADWAY
Mailing Address - Street 2:MANAGED CARE, D1-01
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1329
Mailing Address - Country:US
Mailing Address - Phone:718-334-1921
Mailing Address - Fax:718-334-3432
Practice Address - Street 1:11402 GUY R BREWER BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-1234
Practice Address - Country:US
Practice Address - Phone:718-883-6626
Practice Address - Fax:718-883-6193
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182790208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246075Medicaid
NYG12841Medicare UPIN
NY00246075Medicaid