Healthcare Provider Details

I. General information

NPI: 1588628283
Provider Name (Legal Business Name): DR. MADIHA A ELTAKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 GROVE AVE
CEDAR GROVE NJ
07009-1436
US

IV. Provider business mailing address

204 GROVE AVE
CEDAR GROVE NJ
07009-1436
US

V. Phone/Fax

Practice location:
  • Phone: 973-571-2833
  • Fax: 973-571-2899
Mailing address:
  • Phone: 973-571-2833
  • Fax: 973-571-2899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberMA35788
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMA35788
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: