Provider Demographics
NPI:1568870343
Name:ELSAMANI, HAZIM
Entity Type:Individual
Prefix:
First Name:HAZIM
Middle Name:
Last Name:ELSAMANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 CHESTER AVE
Mailing Address - Street 2:1ST FL.
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-5930
Mailing Address - Country:US
Mailing Address - Phone:862-202-3008
Mailing Address - Fax:908-259-5746
Practice Address - Street 1:86 CHESTER AVE
Practice Address - Street 2:1ST FL.
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-5930
Practice Address - Country:US
Practice Address - Phone:862-202-3008
Practice Address - Fax:908-259-5746
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ100595341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance