Healthcare Provider Details

I. General information

NPI: 1588572739
Provider Name (Legal Business Name): AHMED MOHAMED ELMEKADEM PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 JACKSON RD
BERLIN NJ
08009-2608
US

IV. Provider business mailing address

605 MAGNOLIA CT
MARLTON NJ
08053-1009
US

V. Phone/Fax

Practice location:
  • Phone: 856-809-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ156394000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: