Provider Demographics
NPI:1548481898
Name:ELHADIDY, NABIL A (MD)
Entity type:Individual
Prefix:DR
First Name:NABIL
Middle Name:A
Last Name:ELHADIDY
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 1:1434 WILLIAMSBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2507
Mailing Address - Country:US
Mailing Address - Phone:718-299-7295
Mailing Address - Fax:646-759-5453
Practice Address - Street 1:1434 WILLIAMSBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2507
Practice Address - Country:US
Practice Address - Phone:718-299-7295
Practice Address - Fax:646-759-5453
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194486207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01638499Medicaid
NYF76756Medicare UPIN
NY175162Medicare ID - Type Unspecified