Healthcare Provider Details

I. General information

NPI: 1407482508
Provider Name (Legal Business Name): RAMY ELSAWAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2020
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 CHICAGO AVE UNIT 2120
RIVERSIDE CA
92507-5340
US

IV. Provider business mailing address

18 DEERCHASE LN
LAKEWOOD NJ
08701-5766
US

V. Phone/Fax

Practice location:
  • Phone: 951-223-6654
  • Fax:
Mailing address:
  • Phone: 845-553-4219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number25MA12273700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA12273700
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA199034
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA199034
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: