Healthcare Provider Details

I. General information

NPI: 1336020718
Provider Name (Legal Business Name): MOHAMED ELHAKEEM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR
STRATFORD NJ
08084-1500
US

IV. Provider business mailing address

199 CLINTON AVE
JERSEY CITY NJ
07304-1607
US

V. Phone/Fax

Practice location:
  • Phone: 856-566-7050
  • Fax:
Mailing address:
  • Phone: 551-263-7708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: