Provider Demographics
NPI:1295803674
Name:ABOUEL-ELA, SALLY (MD)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:ABOUEL-ELA
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 1:254 BIRCHWOOD PARK DR
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2307
Mailing Address - Country:US
Mailing Address - Phone:516-939-0597
Mailing Address - Fax:
Practice Address - Street 1:23520 147TH AVE
Practice Address - Street 2:SUITE # 1
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-3293
Practice Address - Country:US
Practice Address - Phone:718-276-1433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238713207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine