Provider Demographics
NPI:1487754164
Name:EL-HABRE, WASSIM G (MD)
Entity type:Individual
Prefix:
First Name:WASSIM
Middle Name:G
Last Name:EL-HABRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WASSIM
Other - Middle Name:G
Other - Last Name:HABRE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:100 E LANCASTER AVE # MSB75
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:484-572-0180
Mailing Address - Fax:484-476-1395
Practice Address - Street 1:100 E LANCASTER AVE # MSB75
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:484-572-0180
Practice Address - Fax:484-476-1395
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA079317002086S0127X
PAMD4374322086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ60028019 & 60028020OtherHORIZON NJ HEALTH
NJP00299827OtherRR MEDICARE
NJ1794613OtherAMERIHEALTH PPO/PABS
NJ2631631000OtherAMERIHEALTH/KEYSTONE/IBC/PABS
NJ0069981Medicaid
NJ3K6045OtherHEALTHNET
NJ010007759 00OtherAMERICHOICE
NJ1091998OtherAETNA
NJ2485398OtherUNITED HEALTHCARE
PA1020798260001Medicaid
NJ42319OtherUNIVERSITY HEALTH PLAN
NJ3K6045OtherHEALTHNET
NJ1091998OtherAETNA