Healthcare Provider Details

I. General information

NPI: 1124824933
Provider Name (Legal Business Name): AYA ELDESOUKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2025
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

981 WESTSIDE AVE
JERSEY CITY NJ
07306-6903
US

IV. Provider business mailing address

625 SUMMIT AVE APT 7N
JERSEY CITY NJ
07306-3729
US

V. Phone/Fax

Practice location:
  • Phone: 201-332-0410
  • Fax:
Mailing address:
  • Phone: 201-920-6483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RJ16024
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: