Provider Demographics
NPI:1205878576
Name:WAKIL, AIDA S (MD)
Entity type:Individual
Prefix:DR
First Name:AIDA
Middle Name:S
Last Name:WAKIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 GREAT OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-5962
Mailing Address - Country:US
Mailing Address - Phone:518-452-6002
Mailing Address - Fax:518-452-6078
Practice Address - Street 1:222 GREAT OAKS BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-5962
Practice Address - Country:US
Practice Address - Phone:518-452-6002
Practice Address - Fax:518-452-6078
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200251207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01597153Medicaid
NYP00125872OtherRAILROAD MEDICARE
NYF89210Medicare UPIN
NY01597153Medicaid