Provider Demographics
NPI:1205186756
Name:ELKHALILI, WALID (MD)
Entity Type:Individual
Prefix:DR
First Name:WALID
Middle Name:
Last Name:ELKHALILI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6-20 PLAZA RD
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-3113
Mailing Address - Country:US
Mailing Address - Phone:201-797-2003
Mailing Address - Fax:201-797-7003
Practice Address - Street 1:6-20 PLAZA RD
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3113
Practice Address - Country:US
Practice Address - Phone:201-797-2003
Practice Address - Fax:201-797-7003
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD458767207R00000X
NJ25MA09576800207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0517321Medicaid