Provider Demographics
NPI:1295872810
Name:WAKED, WILLIAM JOSEPH (PHD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:WAKED
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 PINEHURST AVE APT J52
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-1755
Mailing Address - Country:US
Mailing Address - Phone:121-795-6916
Mailing Address - Fax:
Practice Address - Street 1:30 E END AVE, SUITE 1C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-7053
Practice Address - Country:US
Practice Address - Phone:212-795-6916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011294-1103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV00021Medicare ID - Type Unspecified