Provider Demographics
NPI:1346245560
Name:ELKHOLY, NEVEEN A (DO)
Entity Type:Individual
Prefix:DR
First Name:NEVEEN
Middle Name:A
Last Name:ELKHOLY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1042 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07503-2212
Mailing Address - Country:US
Mailing Address - Phone:973-510-2444
Mailing Address - Fax:973-278-2818
Practice Address - Street 1:1042 MAIN ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503-2212
Practice Address - Country:US
Practice Address - Phone:973-510-2444
Practice Address - Fax:973-278-2818
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2022-05-18
Deactivation Date:2022-04-21
Deactivation Code:
Reactivation Date:2022-05-17
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07428300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ84522Medicaid
NJ1740345693Other741 BROADWAY
NJ1972778413Other1148-1150 SPRINGFIELD AVE
NJ1235300799Other37 N DAY STREET
NJ1932370483Other101 LUDLOW STREET
NJ1194996645Other444 WILLIAM STREET
NJ222747589OtherNCHC EIN
NJ1235300799Other37 N DAY STREET
NJ1740345693Other741 BROADWAY