Provider Demographics
NPI:1083352538
Name:ELIWA, SAMAH
Entity Type:Individual
Prefix:
First Name:SAMAH
Middle Name:
Last Name:ELIWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 SAINT MARKS PL APT 2J
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-1842
Mailing Address - Country:US
Mailing Address - Phone:929-571-8141
Mailing Address - Fax:
Practice Address - Street 1:974 BROADWAY
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-4054
Practice Address - Country:US
Practice Address - Phone:201-471-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04240200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist