Provider Demographics
NPI:1518909290
Name:ELKASSIR, AMINA (MD)
Entity Type:Individual
Prefix:
First Name:AMINA
Middle Name:
Last Name:ELKASSIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:487 EDSALL BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-1942
Mailing Address - Country:US
Mailing Address - Phone:201-224-4300
Mailing Address - Fax:201-224-4397
Practice Address - Street 1:487 EDSALL BOULEVARD
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-1942
Practice Address - Country:US
Practice Address - Phone:201-224-4300
Practice Address - Fax:201-224-4397
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA037812080A0000X
NJ25MA03781600208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJB12706Medicare UPIN