Provider Demographics
NPI:1588760094
Name:WASSEF, WAGIH GIRGIS (MD)
Entity type:Individual
Prefix:
First Name:WAGIH
Middle Name:GIRGIS
Last Name:WASSEF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 RIVER RD
Mailing Address - Street 2:SUITE N1 A AND B
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045
Mailing Address - Country:US
Mailing Address - Phone:973-263-9900
Mailing Address - Fax:973-263-9919
Practice Address - Street 1:150 RIVER RD
Practice Address - Street 2:SUITE N1 A AND B
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045
Practice Address - Country:US
Practice Address - Phone:973-263-9900
Practice Address - Fax:973-263-9919
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA61582207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6806104Medicaid
NJ6806104Medicaid
NJ834986Medicare ID - Type Unspecified
NJ834986UWXMedicare PIN
G21637Medicare UPIN
NJ834986UXKMedicare PIN