MEDICARE: AMINA ELKASSIR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080A0000X	Pediatric Adolescent Medicine Physician	MA03781	NJ
2	208000000X	Pediatrics Physician	25MA03781600	NJ

General Provider Information

NPI Number	:	1518909290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMINA ELKASSIR M.D.

Provider Business Mailing Address
First Line	:	487 EDSALL BOULEVARD
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-1942
Country	:	US
Telephone Number	:	201-224-4300
Fax Number	:	201-224-4397

Provider Business Practice Location Address
First Line	:	487 EDSALL BOULEVARD
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-1942
Country	:	US
Telephone Number	:	201-224-4300
Fax Number	:	201-224-4397

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	04/09/2010

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