Provider Demographics
NPI:1831558105
Name:WAHDAN, ABDELAZIM
Entity type:Individual
Prefix:
First Name:ABDELAZIM
Middle Name:
Last Name:WAHDAN
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:PO BOX 286233
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-0012
Mailing Address - Country:US
Mailing Address - Phone:347-788-2497
Mailing Address - Fax:
Practice Address - Street 1:2373 OCEAN PKWY
Practice Address - Street 2:APT 3A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-5439
Practice Address - Country:US
Practice Address - Phone:347-788-2497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-16
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061431183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist