Provider Demographics
NPI:1194808212
Name:ABO-DEEB, AZZA ABDEL-HAMID (MD)
Entity type:Individual
Prefix:
First Name:AZZA
Middle Name:ABDEL-HAMID
Last Name:ABO-DEEB
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 1:2 STOWE RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-2570
Mailing Address - Country:US
Mailing Address - Phone:914-737-4222
Mailing Address - Fax:914-737-3508
Practice Address - Street 1:2 STOWE RD
Practice Address - Street 2:SUITE 6
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-2570
Practice Address - Country:US
Practice Address - Phone:914-737-4222
Practice Address - Fax:914-737-3508
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002742208000000X
NY258602208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RB2520Medicare PIN