Healthcare Provider Details

I. General information

NPI: 1639730716
Provider Name (Legal Business Name): SHERIF MOHAMED ELKATTAWY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 06/27/2019
Certification Date: ELKATTAWY SHERIF MOHAMED 625 SUMMIT AVE APT 3G JERSEY CITY NJ 07306 225 WILLIAMSON ST ELIZABETH NJ 07202
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 WILLIAMSON ST
ELIZABETH NJ
07202-3625
US

IV. Provider business mailing address

625 SUMMIT AVE APT 3G
JERSEY CITY NJ
07306-3729
US

V. Phone/Fax

Practice location:
  • Phone: 908-994-5420
  • Fax:
Mailing address:
  • Phone: 201-707-1394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: