Healthcare Provider Details

I. General information

NPI: 1225264526
Provider Name (Legal Business Name): ADHAM SAMY KAMEL ELSAYED ELOKDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 02/08/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 GREAT NECK RD
GREAT NECK NY
11021-3357
US

IV. Provider business mailing address

30 BERGEN ST RM 1205
NEWARK NJ
07107-3000
US

V. Phone/Fax

Practice location:
  • Phone: 516-487-2020
  • Fax: 517-487-4950
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number25MA10629200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number271185
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: