Provider Demographics
NPI:1952648941
Name:WAHIB, AMAL
Entity Type:Individual
Prefix:MR
First Name:AMAL
Middle Name:
Last Name:WAHIB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-1607
Mailing Address - Country:US
Mailing Address - Phone:917-699-9257
Mailing Address - Fax:
Practice Address - Street 1:64 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-1607
Practice Address - Country:US
Practice Address - Phone:917-699-9257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0000972-1252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency