Provider Demographics
NPI:1801977533
Name:EL-HARAZY, ESSAM (MD)
Entity type:Individual
Prefix:DR
First Name:ESSAM
Middle Name:
Last Name:EL-HARAZY
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 1:116 EVERTURN LN
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19054-2726
Mailing Address - Country:US
Mailing Address - Phone:609-203-2465
Mailing Address - Fax:609-726-1387
Practice Address - Street 1:NLDC ROUTE 72
Practice Address - Street 2:
Practice Address - City:NEW LISBON
Practice Address - State:NJ
Practice Address - Zip Code:08064
Practice Address - Country:US
Practice Address - Phone:609-726-1000
Practice Address - Fax:609-726-1387
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2010-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07260900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0220248Medicaid
NJ057139ZFYBMedicare PIN