Provider Demographics
NPI:1639290646
Name:MAHGOUB, NAHLA ABDELAZIZ (MD)
Entity Type:Individual
Prefix:
First Name:NAHLA
Middle Name:ABDELAZIZ
Last Name:MAHGOUB
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 1:240 E 76TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-2941
Mailing Address - Country:US
Mailing Address - Phone:212-434-5300
Mailing Address - Fax:
Practice Address - Street 1:GRACIE SQUARE HOSPITAL
Practice Address - Street 2:420 E 76TH ST
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-434-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2398772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY66A561Medicare PIN