Provider Demographics
NPI:1023183589
Name:ELMINI, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:ELMINI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 WANAQUE AVE
Mailing Address - Street 2:
Mailing Address - City:POMPTON LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07442-1806
Mailing Address - Country:US
Mailing Address - Phone:973-616-0666
Mailing Address - Fax:973-616-0666
Practice Address - Street 1:505 WANAQUE AVE
Practice Address - Street 2:
Practice Address - City:POMPTON LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07442-1806
Practice Address - Country:US
Practice Address - Phone:973-616-0666
Practice Address - Fax:973-616-0666
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD 806156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD 806OtherOPTICIANS LICENCE
NJ222669276OtherTAX NO.
NJ0850360002Medicare ID - Type Unspecified