=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609952480
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOHAMED H. ELNAHAL, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2006
-----------------------------------------------------
Last Update Date | 04/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 333 E JIMMIE LEEDS RD EAST BUILDING SUITE 5
-----------------------------------------------------
City | GALLOWAY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08205-4123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-652-5556
-----------------------------------------------------
Fax | 609-652-3330
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 333 E JIMMIE LEEDS RD EAST BUILDING SUITE 5
-----------------------------------------------------
City | GALLOWAY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08205-4123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-652-5556
-----------------------------------------------------
Fax | 609-652-3330
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MOHAMED H. ELNAHAL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 609-652-5556
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 25MA05177500
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------