1356368971 NPI number — DR. ELAINE DENNIS M.D.

Table of content: DR. ELAINE DENNIS M.D. (NPI 1356368971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356368971 NPI number — DR. ELAINE DENNIS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DENNIS
Provider First Name:
ELAINE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHRISTIE
Provider Other First Name:
PIERRO
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356368971
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17 CASINO DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMINGDALE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07727-3701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-938-3580
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4013 ROUTE 9 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOWELL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07731-4021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-905-5255
Provider Business Practice Location Address Fax Number:
732-905-5266
Provider Enumeration Date:
07/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  MD 423829 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207PE0004X , with the licence number: 25MA07164700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10110345 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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