Provider Demographics
NPI:1558446096
Name:ELBABA, MOHAMAD F
Entity Type:Individual
Prefix:DR
First Name:MOHAMAD
Middle Name:F
Last Name:ELBABA
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:FOUAD
Other - Middle Name:
Other - Last Name:EL-BABA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:877 STEWART AVE STE 33
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4803
Mailing Address - Country:US
Mailing Address - Phone:516-745-0015
Mailing Address - Fax:516-227-2544
Practice Address - Street 1:877 STEWART AVE STE 33
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4803
Practice Address - Country:US
Practice Address - Phone:516-745-0015
Practice Address - Fax:516-227-2544
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167102208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics