Provider Demographics
NPI:1396443446
Name:ELWAN, AYMAN SR
Entity type:Individual
Prefix:
First Name:AYMAN
Middle Name:
Last Name:ELWAN
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 STONEHURST BLVD APT A
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-3254
Mailing Address - Country:US
Mailing Address - Phone:732-277-9977
Mailing Address - Fax:
Practice Address - Street 1:63 STONEHURST BLVD APT A
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-3254
Practice Address - Country:US
Practice Address - Phone:732-277-9977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJE56820710009752347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle