Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | MA35788 | NJ |
N | 207R00000X | Internist | MA35788 | NJ |
N | 111NI0900X | Internist | MA35788 | NJ |
NPI | 1588628283 |
---|---|
Provider Name | Dr. Madiha A Eltaki |
First Address | Cedar Grove, NJ 07009-1436 |
Second Address | Cedar Grove, NJ 07009-1436 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6315801 | (05) | NJ |
F16914 | (02) |