Healthcare Provider Details

I. General information

NPI: 1467452565
Provider Name (Legal Business Name): ELSAYED A SAHLOUL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 12/26/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BETHANY RD BLDG #2, STE #25
HAZLET NJ
07730-1660
US

IV. Provider business mailing address

1 BETHANY RD BLDG #2, STE #25
HAZLET NJ
07730-1660
US

V. Phone/Fax

Practice location:
  • Phone: 732-217-3208
  • Fax: 732-217-3107
Mailing address:
  • Phone: 732-217-3208
  • Fax: 732-217-3107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA07118000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number25MA071180
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD451598
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: