Provider Demographics
NPI:1346225927
Name:ELKOULILY, AHMED M (MD)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:M
Last Name:ELKOULILY
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 1:232 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-2623
Mailing Address - Country:US
Mailing Address - Phone:516-594-5961
Mailing Address - Fax:
Practice Address - Street 1:232 MERRICK RD
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-2623
Practice Address - Country:US
Practice Address - Phone:516-594-5961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204874207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01711480Medicaid
NYC42621Medicare UPIN
NY01711480Medicaid