Provider Demographics
NPI:1023470663
Name:ELTAKI, NOHA
Entity type:Individual
Prefix:
First Name:NOHA
Middle Name:
Last Name:ELTAKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:844-362-1735
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:90-10 ROUTE 206
Practice Address - Street 2:SUITE 1
Practice Address - City:BYRAM TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07874
Practice Address - Country:US
Practice Address - Phone:973-500-4344
Practice Address - Fax:973-500-4345
Is Sole Proprietor?:No
Enumeration Date:2016-03-23
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10605000207Q00000X
IL036170583207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine