Provider Demographics
NPI:1497745905
Name:EL SOURY, AHMED ADEL (MD)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:ADEL
Last Name:EL SOURY
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:PO BOX 141280
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-1280
Mailing Address - Country:US
Mailing Address - Phone:718-761-2800
Mailing Address - Fax:718-494-6829
Practice Address - Street 1:251 RICHMOND HILL RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-5906
Practice Address - Country:US
Practice Address - Phone:718-761-2800
Practice Address - Fax:718-494-6829
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60234547207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
7131NOtherEMPIRE BC/BS
NY02636184Medicaid
04-11110OtherEVERCARE
7131NOtherEMPIRE BC/BS
NY285AQ1Medicare ID - Type Unspecified