Provider Demographics
NPI:1689837643
Name:AGHNATIOS ABI JAOUDE, WASSIM (MD)
Entity Type:Individual
Prefix:
First Name:WASSIM
Middle Name:
Last Name:AGHNATIOS ABI JAOUDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WASSIM
Other - Middle Name:
Other - Last Name:ABI JAOUDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:298 LACONIA AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-2312
Mailing Address - Country:US
Mailing Address - Phone:608-335-8856
Mailing Address - Fax:
Practice Address - Street 1:451 CLARKSON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2054
Practice Address - Country:US
Practice Address - Phone:718-245-4686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY269477208G00000X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery