Healthcare Provider Details

I. General information

NPI: 1316335409
Provider Name (Legal Business Name): AMR A EL ELLAE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2014
Last Update Date: 12/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 WOODSTOWN ROAD
SALEM NJ
08079-2080
US

IV. Provider business mailing address

310 WOOD STOWN RD
SALEM NJ
08079
US

V. Phone/Fax

Practice location:
  • Phone: 856-935-1000
  • Fax:
Mailing address:
  • Phone: 856-935-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number241316
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: