1487754164 NPI number — WASSIM G EL-HABRE MD

Table of content: WASSIM G EL-HABRE MD (NPI 1487754164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487754164 NPI number — WASSIM G EL-HABRE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EL-HABRE
Provider First Name:
WASSIM
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HABRE
Provider Other First Name:
WASSIM
Provider Other Middle Name:
G
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1487754164
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 E LANCASTER AVE # MSB75
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WYNNEWOOD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19096-3450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-572-0180
Provider Business Mailing Address Fax Number:
484-476-1395

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 E LANCASTER AVE # MSB75
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WYNNEWOOD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19096-3450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-572-0180
Provider Business Practice Location Address Fax Number:
484-476-1395
Provider Enumeration Date:
09/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2086S0127X , with the licence number:  MA07931700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0127X , with the licence number: MD437432 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 60028019 & 60028020 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P00299827 . This is a "RR MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1794613 . This is a "AMERIHEALTH PPO/PABS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2631631000 . This is a "AMERIHEALTH/KEYSTONE/IBC/PABS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0069981 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3K6045 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 010007759 00 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1091998 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2485398 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1020798260001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42319 . This is a "UNIVERSITY HEALTH PLAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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