MEDICARE: NAGI IBRAHIM ELTEMSAH MD

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	208000000X	Pediatrics Physician	25MA06245800	NJ

General Provider Information

NPI Number	:	1568535367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAGI IBRAHIM ELTEMSAH MD

Provider Business Mailing Address
First Line	:	2775 KENNEDY BLVD
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306
Country	:	US
Telephone Number	:	201-559-5536
Fax Number	:

Provider Business Practice Location Address
First Line	:	2775 KENNEDY BLVD
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306
Country	:	US
Telephone Number	:	201-559-5536
Fax Number	:

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

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	11/07/2023

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