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General NPI Number Information
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NPI Number | 1023819679
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Entity Type | Individual
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Provider Name | MOHAMED ELSAYED ELSAMRA
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Gender | Male
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Dates
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Enumeration Date | 03/20/2025
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 206 BERGEN AVE STE 207
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City | KEARNY
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State | NJ
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Zip | 07032-3387
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Country | US
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Telephone | 631-534-7246
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Fax |
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Provider Business Mailing Address
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Address Line | 13-20 3RD ST
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City | FAIR LAWN
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State | NJ
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Zip | 07410-1151
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Country | US
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Telephone | 862-247-3694
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ15292800
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License Number State | NJ
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