Provider Demographics
NPI:1790176584
Name:ELSISI, AYAT BELAL (PHARMD)
Entity Type:Individual
Prefix:
First Name:AYAT
Middle Name:BELAL
Last Name:ELSISI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-4418
Mailing Address - Country:US
Mailing Address - Phone:732-985-7431
Mailing Address - Fax:
Practice Address - Street 1:45 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-1421
Practice Address - Country:US
Practice Address - Phone:732-882-1057
Practice Address - Fax:732-943-3784
Is Sole Proprietor?:No
Enumeration Date:2015-02-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RW02093400183700000X
NJ28RI03869400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No183700000XPharmacy Service ProvidersPharmacy Technician