Provider Demographics
NPI:1417089228
Name:EL-HAJAL MOUAIKEL, MARLENE HAJAL (MD)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:HAJAL
Last Name:EL-HAJAL MOUAIKEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARLENE
Other - Middle Name:
Other - Last Name:EL-HAJAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:16511 DEER RUN RD
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-5365
Mailing Address - Country:US
Mailing Address - Phone:315-583-6300
Mailing Address - Fax:
Practice Address - Street 1:117 NORTH MECHANIC STREET
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:NY
Practice Address - Zip Code:13619
Practice Address - Country:US
Practice Address - Phone:315-493-4187
Practice Address - Fax:315-493-4188
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206834-1208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00310852Medicaid