Provider Demographics
NPI:1811939101
Name:EL-BABA, FADI (MD)
Entity type:Individual
Prefix:DR
First Name:FADI
Middle Name:
Last Name:EL-BABA
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 1:825 E GATE BLVD
Mailing Address - Street 2:STE 111
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-2136
Mailing Address - Country:US
Mailing Address - Phone:516-804-5200
Mailing Address - Fax:516-240-6540
Practice Address - Street 1:4 TECHNOLOGY DR STE 150
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-4085
Practice Address - Country:US
Practice Address - Phone:631-941-1400
Practice Address - Fax:631-941-1476
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193535207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01441010Medicaid
NY5229034OtherAETNA
NY01441010Medicaid
NY85H62OtherEMPIRE BC.BS
NYE91778Medicare UPIN