Provider Demographics
NPI:1912354895
Name:EL SANABAWY, MARY A
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:EL SANABAWY
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 1:404 CRANBURY RD APT 12
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-3663
Mailing Address - Country:US
Mailing Address - Phone:424-298-1362
Mailing Address - Fax:732-432-0299
Practice Address - Street 1:404 CRANBURY RD APT 12
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3663
Practice Address - Country:US
Practice Address - Phone:424-298-1362
Practice Address - Fax:732-432-0299
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03772200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist