Provider Demographics
NPI:1548288590
Name:HAILOO, WAJDY LOUIS (MD)
Entity type:Individual
Prefix:DR
First Name:WAJDY
Middle Name:LOUIS
Last Name:HAILOO
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 1:210 RONKONKOMA AVE
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-3346
Mailing Address - Country:US
Mailing Address - Phone:631-780-6611
Mailing Address - Fax:631-780-6624
Practice Address - Street 1:210 RONKONKOMA AVE
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-3346
Practice Address - Country:US
Practice Address - Phone:631-780-6611
Practice Address - Fax:631-780-6624
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1692522083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY30F28OtherEMPIRE BC.BS
NY01144430Medicaid
NYB71477Medicare UPIN
NY30F281Medicare ID - Type Unspecified