Provider Demographics
NPI:1922270925
Name:SOULTAN, EMAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:EMAN
Middle Name:A
Last Name:SOULTAN
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 1:6818 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-5803
Mailing Address - Country:US
Mailing Address - Phone:917-385-5991
Mailing Address - Fax:732-369-3468
Practice Address - Street 1:6818 3RD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-5803
Practice Address - Country:US
Practice Address - Phone:917-385-5991
Practice Address - Fax:732-369-3468
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08338200207V00000X
NY254889207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0168751Medicaid
NY03276437Medicaid
NY03276437Medicaid