Healthcare Provider Details

I. General information

NPI: 1073573663
Provider Name (Legal Business Name): HISHAM ELGENAIDI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 KRESSON RD STE 105
CHERRY HILL NJ
08034-3200
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 856-796-9340
  • Fax: 856-547-0390
Mailing address:
  • Phone: 856-355-0340
  • Fax: 856-355-0330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number25MA07809900
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License Number25MA07809900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: