MEDICARE: DR. RAMY ELSAWAH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	25MA12273700	NJ
2	390200000X	Student in an Organized Health Care Education/Training Program		NJ
3	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1407482508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAMY ELSAWAH MD

Provider Business Mailing Address
First Line	:	18 DEERCHASE LN
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5766
Country	:	US
Telephone Number	:	845-553-4219
Fax Number	:

Provider Business Practice Location Address
First Line	:	4020 CHICAGO AVE UNIT 2120
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-5340
Country	:	US
Telephone Number	:	951-223-6654
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2020
Last Update Date	:	03/31/2026

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