Provider Demographics
NPI:1740518943
Name:AYOUB, WISSAM
Entity type:Individual
Prefix:
First Name:WISSAM
Middle Name:
Last Name:AYOUB
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 1:1990 LEXINGTON AVE
Mailing Address - Street 2:C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-2902
Mailing Address - Country:US
Mailing Address - Phone:212-410-4200
Mailing Address - Fax:
Practice Address - Street 1:1990 LEXINGTON AVE
Practice Address - Street 2:C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-2902
Practice Address - Country:US
Practice Address - Phone:212-410-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-27
Last Update Date:2009-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053136183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist