Provider Demographics
NPI:1932291408
Name:ABDALAH, EHAB FAROUK (MD)
Entity Type:Individual
Prefix:DR
First Name:EHAB
Middle Name:FAROUK
Last Name:ABDALAH
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 1:9515 W CAMELBACK RD STE 126
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-1364
Mailing Address - Country:US
Mailing Address - Phone:623-247-0850
Mailing Address - Fax:623-247-0850
Practice Address - Street 1:9515 W CAMELBACK RD STE 126
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-1364
Practice Address - Country:US
Practice Address - Phone:623-247-0850
Practice Address - Fax:623-247-0850
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239123208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ158322Medicaid
AZ36239OtherMEDICAL LICENSE
AZBE7926883OtherDEA
AZ36239OtherMEDICAL LICENSE