Provider Demographics
NPI:1518785914
Name:EL BIALY, SAMAH MOHEB NEMATALLA
Entity type:Individual
Prefix:
First Name:SAMAH
Middle Name:MOHEB NEMATALLA
Last Name:EL BIALY
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 1:294 S WASHINGTON AVE APT 116
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-3734
Mailing Address - Country:US
Mailing Address - Phone:201-310-6183
Mailing Address - Fax:
Practice Address - Street 1:294 S WASHINGTON AVE APT 116
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-3734
Practice Address - Country:US
Practice Address - Phone:201-310-6183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04401200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist