Healthcare Provider Details

I. General information

NPI: 1083942635
Provider Name (Legal Business Name): MOHAMED A ESIELY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2009
Last Update Date: 07/08/2023
Certification Date: 07/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 HUDSON ST STE 204
HOBOKEN NJ
07030-5641
US

IV. Provider business mailing address

79 HUDSON ST STE 204
HOBOKEN NJ
07030-5641
US

V. Phone/Fax

Practice location:
  • Phone: 201-222-5451
  • Fax:
Mailing address:
  • Phone: 201-222-5451
  • Fax: 201-604-6332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA08667800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: