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General NPI Number Information
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NPI Number | 1043266596
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Entity Type | Organization
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Legal Business Name | HOSSAM ELFARRA MD PA
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 03/01/2012
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Provider Practice Location Address
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Address Line | 1300 MAIN AVE STE 1B
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City | CLIFTON
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State | NJ
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Zip | 07011-2266
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Country | US
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Telephone | 973-777-5778
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Fax |
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Provider Business Mailing Address
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Address Line | 7 SKYVIEW RD
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City | WAYNE
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State | NJ
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Zip | 07470-6284
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Country | US
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Telephone | 973-777-5778
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. HOSSAM ELFARRA
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Credential | MD
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Telephone | 973-777-5778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | MA065385
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License Number State | NJ
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