Provider Demographics
NPI:1982611125
Name:BIBAWY, SUZY (MD)
Entity Type:Individual
Prefix:DR
First Name:SUZY
Middle Name:
Last Name:BIBAWY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUZY
Other - Middle Name:NASHED
Other - Last Name:SAAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:86 MICHAEL LOOP
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-4639
Mailing Address - Country:US
Mailing Address - Phone:718-818-5584
Mailing Address - Fax:718-818-6066
Practice Address - Street 1:75 VANDERBILT AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-2604
Practice Address - Country:US
Practice Address - Phone:718-818-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210720207RA0000X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine