Healthcare Provider Details

I. General information

NPI: 1043871395
Provider Name (Legal Business Name): SAMEH ELRABIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 STOCKHOLM ST
BROOKLYN NY
11237-4006
US

IV. Provider business mailing address

319 LYNN DR
FRANKLIN LAKES NJ
07417-2328
US

V. Phone/Fax

Practice location:
  • Phone: 718-963-7602
  • Fax:
Mailing address:
  • Phone: 718-963-7602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number347237-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: