Healthcare Provider Details

I. General information

NPI: 1801977533
Provider Name (Legal Business Name): ESSAM EL-HARAZY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 05/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NLDC ROUTE 72
NEW LISBON NJ
08064
US

IV. Provider business mailing address

116 EVERTURN LN
LEVITTOWN PA
19054-2726
US

V. Phone/Fax

Practice location:
  • Phone: 609-726-1000
  • Fax: 609-726-1387
Mailing address:
  • Phone: 609-203-2465
  • Fax: 609-726-1387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA07260900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: