Provider Demographics
NPI:1831419126
Name:ELSAMMAN, WAEL ALI (MD)
Entity type:Individual
Prefix:
First Name:WAEL
Middle Name:ALI
Last Name:ELSAMMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2125 ROUTE 88 E
Mailing Address - Street 2:OCEAN COUNTY FAMILY CARE
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3273
Mailing Address - Country:US
Mailing Address - Phone:732-942-4455
Mailing Address - Fax:732-942-4459
Practice Address - Street 1:9 MULE RD
Practice Address - Street 2:OCEAN COUNTY FAMILY CARE
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5043
Practice Address - Country:US
Practice Address - Phone:732-818-0004
Practice Address - Fax:732-818-7775
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA08781800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0245712Medicaid
NJ192906YBRYMedicare PIN