Provider Demographics
NPI:1700808219
Name:ELIAS, AHDI IBRAHIM (MD)
Entity Type:Individual
Prefix:
First Name:AHDI
Middle Name:IBRAHIM
Last Name:ELIAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1042 MORRIS TPKE
Mailing Address - Street 2:
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078-1005
Mailing Address - Country:US
Mailing Address - Phone:973-912-0782
Mailing Address - Fax:
Practice Address - Street 1:2839 ROUTE 10 EAST
Practice Address - Street 2:SUITE 202
Practice Address - City:MORRIS PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07950-1200
Practice Address - Country:US
Practice Address - Phone:973-292-9248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA062264207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6789609Medicaid
NJ6789609Medicaid
NJG24661Medicare UPIN
NJ855210Medicare ID - Type UnspecifiedAHDI I ELIAS, MD