Provider Demographics
NPI:1023819679
Name:ELSAMRA, MOHAMED ELSAYED
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:ELSAYED
Last Name:ELSAMRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13-20 3RD ST
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-1151
Mailing Address - Country:US
Mailing Address - Phone:862-247-3694
Mailing Address - Fax:
Practice Address - Street 1:13-20 3RD ST
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-1151
Practice Address - Country:US
Practice Address - Phone:862-247-3694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-20
Last Update Date:2025-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15292800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily