Provider Demographics
NPI:1396356390
Name:ELSABAAWY, MINA M (RPH)
Entity Type:Individual
Prefix:
First Name:MINA
Middle Name:M
Last Name:ELSABAAWY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4120 HEMPSTEAD TPKE
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-5600
Mailing Address - Country:US
Mailing Address - Phone:516-520-8809
Mailing Address - Fax:
Practice Address - Street 1:4120 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-5600
Practice Address - Country:US
Practice Address - Phone:516-520-8809
Practice Address - Fax:516-520-2958
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03913000183500000X
NY067084183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist