Provider Demographics
NPI:1790934784
Name:MAGDY SHAABAN PHYSICIAN PC
Entity Type:Organization
Organization Name:MAGDY SHAABAN PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAGDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHAABAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-223-0700
Mailing Address - Street 1:865 MERRICK ROAD SUITE 303
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510
Mailing Address - Country:US
Mailing Address - Phone:516-223-0700
Mailing Address - Fax:516-223-5347
Practice Address - Street 1:865 MERRICK RD STE 303
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-3338
Practice Address - Country:US
Practice Address - Phone:516-223-0700
Practice Address - Fax:516-223-5347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183174207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01836511Medicaid
NY01836511Medicaid