Provider Demographics
NPI:1902071830
Name:QUEENS PERIOPERATIVE MEDICAL ASSOCIATES, PLLC
Entity type:Organization
Organization Name:QUEENS PERIOPERATIVE MEDICAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WAGIH
Authorized Official - Middle Name:AGEEB
Authorized Official - Last Name:SAWERIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-672-2824
Mailing Address - Street 1:PO BOX 266
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-0266
Mailing Address - Country:US
Mailing Address - Phone:718-672-2824
Mailing Address - Fax:718-672-4251
Practice Address - Street 1:8212 151ST AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-1761
Practice Address - Country:US
Practice Address - Phone:718-672-2824
Practice Address - Fax:718-672-4251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188256-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG100000253Medicare PIN