Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 22DI02797800 | NJ |
NPI | 1124403795 |
---|---|
Provider Name | Dr. Heba Elkassaby |
First Address | Fort Lee, NJ 07024-5027 |
Second Address | Newark, NJ 07103-2495 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2015 |
Last Update Date | 06/06/2020 |