Provider Demographics
NPI:1003550864
Name:ELGON BUSINESS GROUP INC
Entity Type:Organization
Organization Name:ELGON BUSINESS GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARRIET
Authorized Official - Middle Name:
Authorized Official - Last Name:KIDDU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-701-6172
Mailing Address - Street 1:903 MAIN ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-7445
Mailing Address - Country:US
Mailing Address - Phone:781-701-6172
Mailing Address - Fax:
Practice Address - Street 1:903 MAIN ST UNIT A
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-7445
Practice Address - Country:US
Practice Address - Phone:781-701-6172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory