Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 25MA04140400 | NJ |
NPI | 1710081336 |
---|---|
Provider Name | Magdy Elamir |
First Address | Jersey City, NJ 07306-0440 |
Second Address | Jersey City, NJ 07306-2707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D06410 | (02) | NJ |