Provider Demographics
NPI:1659339141
Name:SAYEGH, MICHAEL SALEM WAHBAN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SALEM WAHBAN
Last Name:SAYEGH
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 1:21 LAUREL AVE
Mailing Address - Street 2:SUITE 2020
Mailing Address - City:CORNWALL
Mailing Address - State:NY
Mailing Address - Zip Code:12518-1469
Mailing Address - Country:US
Mailing Address - Phone:845-534-5800
Mailing Address - Fax:845-534-2464
Practice Address - Street 1:21 LAUREL AVE
Practice Address - Street 2:SUITE 2020
Practice Address - City:CORNWALL
Practice Address - State:NY
Practice Address - Zip Code:12518-1469
Practice Address - Country:US
Practice Address - Phone:845-534-5800
Practice Address - Fax:845-534-2464
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2008-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204919207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1815856Medicaid
NY1815856Medicaid
NY94T311Medicare ID - Type Unspecified