Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 25MA08345400 | NJ |
Y | 207L00000X | Anesthesiologist | 266300-1 | NY |
NPI | 1013181221 |
---|---|
Provider Name | Kareem Eltaki Eltaki |
First Address | Suffern, NY 10901-4927 |
Second Address | Suffern, NY 10901-4812 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2008 |
Last Update Date | 25/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0165476 | (05) | NJ |
03016373 | (05) | NY |
125458 | MEDICARE (01) | |
P00748634 | RAILROAD MEDICARE (01) |