Provider Demographics
NPI:1124400288
Name:ELGIBALY, MOSTAFA S
Entity Type:Individual
Prefix:
First Name:MOSTAFA
Middle Name:S
Last Name:ELGIBALY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:AVON BY THE SEA
Mailing Address - State:NJ
Mailing Address - Zip Code:07717-1207
Mailing Address - Country:US
Mailing Address - Phone:848-223-2155
Mailing Address - Fax:
Practice Address - Street 1:216 ROUTE 36
Practice Address - Street 2:WALGREENS STORE 5201
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1305
Practice Address - Country:US
Practice Address - Phone:732-728-2283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03706700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist