Provider Demographics
NPI:1942418702
Name:ASSAAD, WAGDI NASSIF
Entity Type:Individual
Prefix:
First Name:WAGDI
Middle Name:NASSIF
Last Name:ASSAAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 SHERIDAN BLVD
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3220
Mailing Address - Country:US
Mailing Address - Phone:516-502-5876
Mailing Address - Fax:
Practice Address - Street 1:231 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-1707
Practice Address - Country:US
Practice Address - Phone:516-746-0276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026018225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist