Provider Demographics
NPI:1598706210
Name:SAWERIS, WAGIH (MD)
Entity Type:Individual
Prefix:
First Name:WAGIH
Middle Name:
Last Name:SAWERIS
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 1:1 BROOKDALE PLAZA
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212
Mailing Address - Country:US
Mailing Address - Phone:718-240-5353
Mailing Address - Fax:718-240-6896
Practice Address - Street 1:1 BROOKDALE PLAZA
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212
Practice Address - Country:US
Practice Address - Phone:718-240-5353
Practice Address - Fax:718-240-5367
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188256207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01428275Medicaid
NY01428275Medicaid
F45456Medicare UPIN