Individual
DR. MOHAMED A ELBASTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MS, PHDC
Contact information
Practice address
100 COMMONS WAY, STE 130, HOLMDEL, NJ 07733
(732) 615-0700
(732) 615-9152
Mailing address
100 COMMONS WAY, STE 130, HOLMDEL, NJ 07733
(732) 615-0700
(732) 615-9152
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
036877
NY
122300000X
Dentist
Primary
22DI01987400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00763373
—
NY
05
—
0623035
—
NJ
Enumeration date
11/25/2005
Last updated
03/28/2017
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