Provider Demographics
NPI:1811492275
Name:ELASSA, NOUR EL HOUDA
Entity type:Individual
Prefix:
First Name:NOUR
Middle Name:EL HOUDA
Last Name:ELASSA
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:443-621-7358
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:477 BROADWAY
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-4797
Practice Address - Country:US
Practice Address - Phone:551-214-3980
Practice Address - Fax:551-214-3879
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB11157300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine