Healthcare Provider Details

I. General information

NPI: 1730490558
Provider Name (Legal Business Name): SAMEH ABDELAHAD ABDELATY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 HAMBURG TPKE
WAYNE NJ
07470-6226
US

IV. Provider business mailing address

175 E 96TH ST
NEW YORK NY
10128-6200
US

V. Phone/Fax

Practice location:
  • Phone: 973-839-3400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number054444
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: