Healthcare Provider Details

I. General information

NPI: 1528060142
Provider Name (Legal Business Name): RAEF A ELGAWLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6314 BLACK HORSE PIKE
EGG HARBOR TOWNSHIP NJ
08234-5543
US

IV. Provider business mailing address

PO BOX 237
NORTHFIELD NJ
08225-0237
US

V. Phone/Fax

Practice location:
  • Phone: 609-813-2190
  • Fax:
Mailing address:
  • Phone: 609-813-2190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA06020200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: