Provider Demographics
NPI:1225264526
Name:KAMEL ELSAYED ELOKDA, ADHAM SAMY (MD)
Entity Type:Individual
Prefix:
First Name:ADHAM
Middle Name:SAMY
Last Name:KAMEL ELSAYED ELOKDA
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 1:30 BERGEN ST RM 1205
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107-3000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:170 GREAT NECK RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-3357
Practice Address - Country:US
Practice Address - Phone:516-487-2020
Practice Address - Fax:517-487-4950
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA106292002084V0102X
NY2711852084V0102X, 2084N0600X, 2084V0102X
NH189682084N0400X
FLME1360312084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3116751Medicaid
NY03364734Medicaid
NJ0710415Medicaid