Basic Information
| Provider Information | |||||||||
| NPI: | 1649589870 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | DOUS | ||||||||
| FirstName: | SAFWAT | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6717 60TH ST UNIT 2 | ||||||||
| Address2: | 2 | ||||||||
| City: | RIDGEWOOD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113854532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262777380 | ||||||||
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| Practice Location | |||||||||
| Address1: | 374 STOCKHOLM ST | ||||||||
| Address2: | WYCKOFF HEIGHTS MEDICAL CENTER | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112374006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189637272 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2010 | ||||||||
| LastUpdateDate: | 12/25/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | A118010 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.