Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 25MA10510400 | NJ |
N | 207QS0010X | Family Doctor - Sports Medicine | 25MA10510400 | NJ |
N | 207QS0010X | Family Doctor - Sports Medicine | A146230 | CA |
NPI | 1194136697 |
---|---|
Provider Name | Bishoy Wassef |
First Address | Linden, NJ 07036-5638 |
Second Address | West Orange, NJ 07052-4112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2014 |
Last Update Date | 04/10/2021 |