Provider Demographics
NPI:1891958674
Name:SOUSSAN, ELIE R (MD)
Entity Type:Individual
Prefix:
First Name:ELIE
Middle Name:R
Last Name:SOUSSAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:34 SYCAMORE AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:LITTLE SILVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07739-1228
Mailing Address - Country:US
Mailing Address - Phone:732-747-9310
Mailing Address - Fax:732-747-9320
Practice Address - Street 1:34 SYCAMORE AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:LITTLE SILVER
Practice Address - State:NJ
Practice Address - Zip Code:07739-1228
Practice Address - Country:US
Practice Address - Phone:732-747-9310
Practice Address - Fax:732-747-9320
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA08834200207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology